Bulletin of the North Carolina Board of Health

library of
CI]e University of Hortl] Carolina
C O L L K C TI O N OF
NORTH C A R (3 L I N I A N A
K N D O W E D BY
JOHN SPRUNT HILL
of the class of 1889
This book must not
be token from the
Librory building.
Form No. 471
iBiiTHiX^EiTinsr
OF THE
North Carolina Board of Health.
Published Monthly at the Office of the Secretary of the Board, Raleigh, N. C.
Geo. G. Thomas, M. D., Pres., Wilmington.
S. "Westray Battle, M. D...Asheville.
Hexry W. Lewis, M. D Jackson.
Hexry H. Dodson, M. D Milton.
*C. J. O'Hagax, M. D Greenville.
J. L. Nicholson, M. D Richlands.
Albert Anderson, M. D "Wilson.
A. "W. Shaffer, Sa.\, Eng Raleigh.
Richard H. Lewis, M. D., Secretary and Treasurer, Raleigh.
Vol. XVI. APRIL, 1901. No. 1.
County Sanitary Committees.
The County Sanitary Committee being a
new body just created by the recently ad-journed
Legislature, we feel that it would not
be amiss to call attention to the very impor-tant
duty required of it in the immediate
futJire, namely, the election of a county super-intendent
of health.
According to section 7 of the same the
time of meeting shall be "for the election of
a county superintendent of health on the first
Monday in May, 1901, and every tw'o years
thereafter."
•In section 5 of the Act Relating to the
Board of Health, as amended, we find these
words: "They (the county sanitary commit-tee)
shall elect a registered physician, not a
member of the sanitary committee, to serve
two years, with the title of county superin-tendent
of health, and shall fix his compen-sation."
This is by far the most important
of the duties imposed upon the committee,
for upon the character and qualifications of -
* Deceased.
the superintendent of health depends the
success or failure of the administration of the
law bearing on the health interests of the
people of the county. The position of super-intendent
of health is no sinecure at any
time if he does his duty, requiring as it does
intelligence, conscientiousness and nerve or
"back-bone." AVhile this' is particularly
true during the prevalence of sniall-pox it is
likewise true at all times, for few counties
are rarely ever entirely free of a preventable
disease of some kind, notably typhoid fever,
scarlet fever or diphtheria. Although the
principal duties of the superintendent are
specifically set forth in sections 56 and 58
and others of the act, there is no specification
as to typhoid fever, but in section 5 a gen-eral
clause is inserted in these words: "The
duty of the county superintendent of health
shall be to carry out as far as possible such
work as may be directed by the county sani-tary
committee and by the State Board of
Health," to cover such sanitary wcfrk as may
not have been mentioned in detail. In this
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
connection we would respectfully suggest that
the sanitary committee make it one of the
specific duties of the superintendent, imme-diately
upon the occurrence of a case of
typhoid fever in his county, to apply to the
Secretary of the State Board of Health for
a permit for a bacteriological analysis of the
drinking water of the family in which the
case occurs or make it his business to see that
the attending physician makes the applica-tion
and has the analysis made 'promptly.
The reasons for this will he found in the
article following.
The responsibilities of the superintendent
being great, an inferior man cannot be ex-pected
to meet them fully. We feel sure
that the county authorities—the board of
county commissioners is practically the
county saniiary comiiiittee—cannot make a
better investment for their people than in
electing a good man and paying him a rea-sonably
fair salary. In regard to this ques-tion
of salary we beg leave to repeat a sug-gestion
previously made in a circular-letter
to the chairmen of the hoards of commis-sioners
to the eflfect that in fixing the salary
of the superintendent an understanding
should be had with him that if called upon
to treat cases of small-pox, which would
greatly cripple if not entirely destroy his
private practice, for the time being and for
some time thereafter,'lie would receive extra
compensation—a certain'definite amount per
day or per month. This would be only sim-ple
justice, and a clear understanding on this
point in the beginning would be more satis-factory
to both parties. The experience of
the past three years have shown that the
counties having efiicient superintendents cor-dially
suppoiled by their boards of commis-sioners
have come out of smallpox outbreaks
at much less expense than others in which
the conditions were different.
In conclusion, we wish to impress upon all
sanitary committees that they must elect a
county superintendent of health on the first
Monday in May, 1901. No discretion is left
them, but the law is mandatory. "
Bacteriological E^xamtuatious.
Our readers wii! doubtless remember read-ing
in these columns a few months ago a state-ment
of the enlightened and generous offer
made by our Department of Agricultural to
have made in its biological laboratory free
of charge bacteriological examinations of
all suspected drinking waters. It is with
much regret that we note the failure of our
physicians to take advantage of that offer to
any extent, there having been less than a
half dozen applications for such examina-tions.
It is certainly not because of a lack of
typhoid fever, for we find that it was present
last month in 11 counties. We are at a loss
to understand the want of appreciation
shown by the profession unless it is due to
force of habit. It is so well known that an in-fected
well or spring is at the bottom of most
cases typhoid fever, thai whenever a case
occurs a warning as to the water supply is
sounded. Intheinterf stof theother members
of the family in which the case occurs it is
clearly the duty of the attending physician
to ascertain as soon as pcs=;ible the cause of
the attack and, having found it, to protect
the family and others liable to come within
its reach against it. To do this in most in-stances
would require very little time or
trouble and the expenditure of ten cents in
postage, which t*^ family would no doubt
be only too gU "^p'y- We sincerely
hope that hereafter every physician in the
Stale wiio has a case of oid fever
will, as soon as the diagno. is made, or
even strongly suspected, write us for a per-mit,
which, together with instructions and a
sterilized bottle, will be gladly and promptly
sent. While on the subject of typhoid fever
we think it proper to call attention to an-
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
other source of infection, the fly, by copy-ing
the following short article from the last
number of the Bulletin of the Bacteriokgi-ca'
and Pathological Laboratory of the Dele-ware
State Board of Health :
A NEWLY RECOGNIZED SOURCE OP
INFECTION.
Top severe epidemic of typhoid fever in
Y>'ir troops in the late Americo-Spanish war
' as well as the numerous experiments on the
subject, bring to light the important fact
that typhoid fever is not only a "water-borne"
but to a great extent a "fly-bred"
disease. In a very able paper published in
the Popular Science Monthly, January, 1901,
("Flies and Typhoid Fever") Dr. Howard
states the following conclusions:
1. "In the army camps the latrines are
not properly cared for and where their con-tents
ai*e left exposed, Musca domestica
(the "house-fly") will, and does, breed in
these contents in large numbers, and is
attracted to them without necessary oviposi-tion.
2. " In towns where the box privy nuisance
is still in existence the house fly is attracted
to such places to a certain extent, though
not as abundantly as other flies, which,
however, are not found in houses.
3. " In the filthly regions of a city, where
sanitary supervision is lax, and where in
low alleys and corners and vacant lots
deposits are made by dirty people, the house-fly
is attracted to the stools, may breed in
them, and is thus a constant source of danger.
The writer has seen a '' nsit, made over
night in South Was' .n an alleyway
swarming with flies in the bright sunlight
of a June l 'ng, temperature 92° F., and
within thirty ..et of this substance were the
open doors and windows of the kitchens of
two houses occupied by poor people."
With regards to the various species of
flies the author has reached the following
conclusions:
1. "Of the seventy-seven species of flies
found under such conditions that their
bodies, especially their feet and their pro-boscides,
may become covered with virulent
typhoid germs, only eight are likely to carry
them to objects from which they can enter
the alimentary canal of man.
2. "Of these eight species, two, namely,
Lucilia coesas and Calliphoro erylhrocephala,
can very rarely carry such germs, though
they may carry the germs of putrifaction
and cause blood-poisoning, in lighting upon
abrasions of the skin or open wounds.
3. "Four of these specimens, namely,
Homaloymia camiculans Muscina siabulosus,
Phora femoraia and Sarcophaga triviolis,
possess some degree of importance, but
their comparative scarcity in houses renders
ihem by no means of prime importance.
4. "The common iittlefruit fly, Dorsophila
ampelophia, is a dangerous species.
5. "The house- fly is a constant source of
danger, and wherever the least carelessness
in the disposal or the disinfection of dejecta
exists, it becomes an imminent source of
danger."
The conclusion to be drawn from the above
is plain: always thoroughly disinfect the
bowel discharges (as the law requires) and
bury them.
A ^Vord ^vitli Siiperiuteiideiits of Healtb.
On the first Monday in May a superin-tendent
must be elected in every county. In
many if not most instances the present in-cumbents
will probably be re-elected, but in
many others new men will come into office.
We desire to call the attention of all out-going
siiperintendents to the importance of
their turning over immediately to their suc-cessors
such blanks, placards and literature
as they may have on hand and particularly
the little book on " Disinfection and Disin-fectants,"
recently sent out. Of all super-intendents,
those re-elected as well as the
new men, we make the earnest request that
they promptly notify us of their election.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
New Memljer! of tlie State Board of
Health.
His Excellency, Governor Aycock, has ap-pointed
the following gentlemen, their term
of oflBce to begin at the next meeting of the
Board, which will be held in Durham at the
time of the aieeting of the State Medical
Society, as required by law, probably during
the week in May beginning with the 20th,
although the local committee of arrange-ments
has not yet announced the exact date:
Drs. W. P. Ivey of Lenoir, and Richard H.
Lewis of Raleigh, for six years ; Drs. George
G.Thomas of Wilmington, and Francis Duffy
of New Bern, for four years; and Mr. J. L.
Ludlow, C. E., of Winsion-Salem, for two
years. Saving ourself the selections are ad-mirable,
the medical members being gener-ally
recognized among the strongest men in
the profession, and Mr. Ludlow being widely
known not cnly in this State but throughout
the South as a well-tquipped and successful
civil and sanitary engineer. But they follow
excellent men, from all of whom we part
officially with genuine regret.
R,evie-*v of Diseases for Marcli, 1901.
EIGHTY-XINE COUNTIES REPORTING.
Ninety-four counties have Superinten-dents
of Health.
Except in the case of the more conta-gious
and dangerous diseases the Super-intendent
has, as a rule, to rely upon his
own information alone, since few phy-sicians
can be induced to report cases of
non-contagious diseases to him.
Where the number of cases is not given
or the prevalence of a disease otherwise
indicated, its mere presence in the county
is to be understood as reported.
For the month of March the following
diseases have been reported from the
counties named:
Measles.—Alamance, a few cases; Beau-fort,
4; Biaden; Brunswick, several ; Bun-combe;
Burke, in all parts; Cabarrus, many;
Caldwell, 10; Carteret, several; Cherokee,
150 to 200; Clay, several; Cleveland, sev-eral;
Columbus; Dare, 18; Davidson; Dur-ham,
a few; Forsyth, in all parts; Gaston;
Gates, epidemic; Granville, 2; Guilforid, 2;
Haywood; Henderson, 13; Hyde, in all
parts; Jackson, 21; Johnston; Lincoln, in
all parts; McDowell; Macon, 4; Mecklen-burg,
50; Mitchell, many; Montgomery, 25;
New Hanover, 88; Onslow, 30; Pasquotank,
a few; Pender, in all parts; Perquimans, 60;
Polk, 4; Randolph, 25; Richmond, 20; Robe-son,
epidemic; Rutherford, in all parts;
Sampson, iu all parts; Scotland, 5; Stokes,
8; Swain, a few; Union, epidemic; Vance, a
few; Wake, 12; Washington, 6; Yancey,
many—51 counties.
Whooping-cough.—Alamance, a few
cases; Alexander; Ashe, 4; Beaufort, 2; Cald-well,
20; Craven, 6; Durham, a few; Gaston;
Granville, 15; Iredell, many; Jackson, in
all parts; Johnston; Lincoln, in all parts;
McDowell; Madison, 75; Martin, 10; Meck-lenburg,
a few; New Hanover, 1; Pasquo-tank,
a few; Polk, 1; Randolph, 10; Robe-son;
Rowan, 12; Surry, 6; Union, 2; Vance,
a few ; Wake, 14 ; Wayne, a few—27 coun-ties.
Scarlet Fever.—Buncombe, 2; Cald-well,
2; Davidson, 4; Franklin, 1; Jack-son,
a few; Mecklenburg, 1; Nash, 1; New
Hanover, 1; Wake, 2; Washington, 6—10
counties.
Diphtheria.—Ashe, 2; Brunswick, 2;
Halifax, 1; Macon, 1; Wake, 3—5 counties.
Typhoid Fever.—Beaufort, 4 ; Bertie, 1;
Brunswick, several; Buncombe, 2; Craven,
4; Harnett, a few; Jones, 1; Madison, 7;
Orange, 1; Wake, 1—11 counties.
Malarial Fever.—Caswell ; Lenoir
;
Perquimans.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Influenza.—Ashe; Beaufort; Bertie; Bla-den;
Cabarrus, general ; Catawba; Chatham,
general; Cherokee; Chowan, general ; Clay;
Cleveland; Currituck; Davidson; Franklin;
Gates ; Greene ; Harnett, general ; Haywood
;
Henderson; Iredell; Jackson, general; Jones;
Lenoir, general ; McDowell ; Macon ; Martin
general ; Montgomery ; Moore ; Nash ; New
Hanover; Northampton; Onslow; Orange;
Pender, general; Person; Pitt, general;
Randolph; Richmond; Robeson; Rocking-ham;
Sampson; Stokes; Surry, general; Swain;
Union ; Vance; Wake; Washington, general
;
Wayne; Yadkin, general—50 counties.
Pneumonia.—Ashe; Beaufort, in all parts
Bertie, in many parts ; Cabarrus, in all parts
Chatham; Chowan, Davie, Gates, in all parts;
Graham; Greene, in all parts; Harnett, in
many parts; Hertford; Hyde; Iredell; Jack-son,
in all parts; Jones; Lenoir, in nearly
all parts ; Martin; Northampton, in all parts
Perquimans; Pitt, in all parts; Richmond;
Robeson; Sampson, in nearly all parts;
Stanly; Swain; Union; ^Vake, in all parts;
Wayne; Yadkin, in nearly all parts—30
counties.
Mumps.—Caswell, 500; Franklin, in
nearly all parts; Guilford; Yadkin.
Varicella.—Jones, 2; McDowell; W^il-son,
in nearly all parts.
Simple Continued Fever.—Graham.
Small-pox.—Buncombe, 12 ; Cabarrus, 8
;
Chatham, 5; Cleveland, 4; Davidson, 31;
Durham, 38; Forsyth, 1; Greene, 17; Guil-ford,
7; Halifax, 1; Mecklenburg, 45; Nash,
3; Orange, 30; Pasquotank, 3; Person, 6;
Polk, 2; Robeson, 13; Wake, 5—18 counties.
Cholera in Hogs.—Ashe, Bertie, Cho-wan,
Cleveland, Hyde, Lenoir.
Distemper in Horses.—Chowan, Cleve-land,
Macon, Swain.
Hydrophobia IN Dogs.— Caswell.
No diseases reported from Edgecombe,
Warren, Watauga and Wilkes.
No reports received from Alleghany, An-son,
Cumberland, Duplin and Transylvania.
Snmmai'y of Mortuary Reports for
3Iarcli, 1901.
(twenty-five towns).
Only those towns frooa which certified
reports are received are included.
Aggregate popula- ^Vhite. Col'd. Total.
tion 77,539 49,151 126,890
Aggregate deaths... 106 108 214
Representing tem-porary
annual
death rate per
1,000 16.4 26.4 20.2
Causes of Death.
Typhoid fever 2 2
Scarlet fever 10 1
Malarial fever 2 2
Whooping-cough ..0 3 3
Measles 1 1
Pneumonia 25 19 44
Consumption 13 16 29
Brain diseases 5 6 11
Heart diseases 11 9 20
Neurotic diseases... 2 2 4
Diarrhceal diseases 12 3
All other diseases.. 41 47 88
Accident 3 2 5
Suicide Oil
106 108 214
Deaths under five
vears 20 19 39
Still-born 18 9
BULLETIN OP THE NORTH CAROLINA BOARD OP HEALTH.
Mortusjcj Report for March, 1901.
Towns
AND RePOUTEKS.
BULLETIN OF THE NORTH CAEOLIXA BOARD OF HEALTH.
County Superintendents of Health.
Alamance Dr. T. S. Faucette.
Alexander Dr. T. F. Stevenson.
Alleghanj' Dr. B. C. Waddell.
Anson Dr. E. S. Ashe.
Ashe Dr. Manley Blevins.
Beaufort Dr. P. A. Nicholson.
Bertie Dr. H. V. Dunstan.
Bladen Dr. Newton Robinson.
Brunswick Dr. J. A. McNeill.
Buncombe Dr. James Sawyer.
Burke Dr. J. L. Laxton.
Cabarrus Dr. D. G. Caldwell.
Caldwell Dr. A. A. Kent.
Camden
Carteret Dr. F. M. Clark.
Caswell Dr. S. A. Malloy.
Catawba Dr. Geo. H. West.
Chatham Dr. H. T. Chapin.
Cherokee Dr. J. F. Abernathy.
Chowan Dr. T. J. Hoskins.
Clav Dr. J. M. Sullivan.
Cleveland Dr. B. H. Palmer.
Columbus Dr. I. Jackson.
Craven Dr. R DuA^al Jones.
Cumberland Dr. J.YanceMcGougan.
Currituck Dr. H. M. Shaw.
Dare .Dr. W. B. Fearing.
Davidson Dr. Joel Hill.
Davie Dr. James IMcGuire.
Duplin Dr. James W. Blount.
Durham Dr. Z. T. Brooks.
Edgecombe Dr. L. L. Staton.
Forsyth Dr. John Bynum.
Franklin Dr. E. S. Foster.
Gaston Dr. J. H. Jenkins.
Gates Dr. W. 0. P. Lee.
Graham Dr. R. J. Orr.
Granville Dr. S. D. Booth.
Greene Dr. Joseph E. Grimsley.
Guilford Dr. Edmund liarrieon.
Halifax Dr. I. E. Green.
Harnett Dr. 0. L. Denning.
Haywood Dr. F. M. Davis.
"
Henderson Dr. J. G. Waldrop.
Hertford Dr. John W. Tayloe.
Hyde Dr. E. H. Jones.
Iredell Dr. Henry F. Long.
Jackson Dr. Wm. Self.
Johnston Dr. L. D. \yharton.
Jones Dr. S. E. Koonce.
Lenoir Dr. W. T. Parrott.
Lincoln Dr. T. F. Costner.
McDowell Dr. B. A. Cheek.
Macon Dr. F. L. Siler.
Madison Dr. Jas. K. Hardwicke.
Martin Dr. W. H. Harrell.
jMecklenburg Dr. F. M. Winchester.
Mitchell Dr. V. R. Butt.
Montgomery Dr. M. P. Blair.
Moore Dr. Gilbert McLeod.
Nash Dr. J. P. Battle.
New Hanover Dr. W. D. McMillan.
Northampton Dr. H. W. Lewis.
Onslow Dr. E. L. Cox.
Orange Dr. C. D. Jones.
Pamlico
Pasquotank Dr. H. T. Aydlett.
Pender Di-. L. L. Ardrey.
Perquimans Dr. C. C. Winslow.
Person Dr. J. A. Wise.
Pitt Dr. C. O'H. Laughing-house.
Polk Dr. Earle Gradv.
Randolph Dr. T. T. Ferree.
Richmond Dr. J. M. Ledbetter.
Robeson Dr. H. T. Pope.
Rockingham Dr. Sam Ellington.
Rowan Dr. W. L. Crump.
Rutherford Dr. W. A. Thompson.
Sampson Dr. R. E. Lee.
Scotland Dr. A. W. Hamer.
Stanly Dr. V. A. Whitley.
Stokes Dr. W. V. McCanlesa.
Surry Dr. John R. Woltz.
Swain Dr. J. A. Cooper.
Transylvania Dr. C. W. Hunt.
Tyrrell
Union Dr. J. E. Ashcraft.
Vance Dr. Goode Cheatham.
Wake Dr. J. J. L. McCullers.
Warren Dr. A. S. Pendleton.
Washington Dr. W. H. Ward.
Watauga Dr. E. F. Bingham.
Wayne Dr. Williams Spicer.
Wilkes Dr J. M. Turner.
Wilson Dr. W. S. Anderson.
Yadkin Dr. S. L. Russell.
Yancey Dr. W. M. Austin.
BULLETIN OF THE NORTH CAHOLINA BOAKD OP HEALTH. 9
[You are asked to fill out and mail one of these forms to the Superintendent of Health of your
county on or before the third of each month, that he may use it in making his report to the Secretary
of the State Board. ]
•
Have any of the following diseases occurred in your practice during the montli
just closed. If so, state number of cases.
Whooping-cough Typhoid Fever _
Measles • Typhus Fever
Diphtheria Yellow Fever
Scarlet Fever Cholera
Pernicious Malarial Fever Smallpox
Hemorrhagic Malarial Fever Cerebro-spinal Meningitis-
What have been the prevailing diseases in your practice?
Has any epidemic occurred among domestic animals? If so, what?
What is the sanitary condition of your section, public and private?
General Remarks:
M. D.
.190--- N. C.
B"crx-jiL:H!i:z3^
OF THE
North Carolina Board of Health.
Published Monthly at the Office of the Secretary of the Board, Raleigh, N. C.
Geo. G. Thomas, M. D., Pres., Wilmington.
S. "Westray Battle, M. D...Asheville
Henry W. Lewis, M. D Jackson.
Henry H. Dodson, M. D Milton.
*C. J. O'Hagan, M. D Greenville.
J. L. Nicholson, M. D Richlands.
Albert Anderson, M. D Wilson.
A. W. Shaffer, San. Eng Raleigh.
Richard H. Lewis, M. D., Secretary and Treasurer, Raleigh.
Vol. XVI. MAY, 1901. No. 2.
Iixflt^euza as a Factor of Recent
Mortality.
In view of our own experience during the
past winter and spring in the unusual mor-tality
from pneumonia, very often as a
feature of influenza or la grippe, we feel
that no apology is required for devoting a
large part of our space to the following very
interesting and instructive discussion of the
above subject which we find in the Monthly
Bulletin for March of the Department of
Health of the City of Chicago:
influenza as a factor of recent
mortality.
Pneumonia has displaced the "Great
White Plague"—pulmonary consumption
—
as the principal cause of death in Chicago
during the last ten years. In the previous
half century consumption had levied the
heaviest toll on human life in this city, but
Deceased.
in the decade 1891-1900 there were nine
per cent, more deaths from pneumonia than
from consumption.
Between 1851 and 1890, inclusive, during
which period deatl)s and their causes were
recorded with increasing accuracy and full-ness,
there were 25,719deaths from consump-tion
and 16,577 from pneumonia—9,182, or
more than thirty-five per cent, excess of
consumption deaths. Between 1891 and 1900,
inclusive, there were 22,957 deaths from
consumption and 25,228 deaths from pneu-monia—
2,271, or nine per cent, excess of
pneumonia deaths.
In the decade 1881-1890 there were
147,514 deaths recorded from all causes
—
out of which number there were 9,915 from
pneumonia, or 672 deaths from this cause
out of every 10,000 deaths from ail causes.
In the last decade, 1891-1900, there were
247,240 deaths recorded from all causes, in-cluding
25,228 deaths from pneumonia—or
1,019 deaths from pneumonia out of every
10,000 deaths from all causes.
12 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
In the furmer decade the death rate of
pneumonia was 12.36 per 10,000 of popula-tion.
In the last decade this death rate was
18.03 per 10,000 of population.*
The forgeoing figures show an increase of
nearly forty-six (45.8) per cent, in pro-portion
to population and of more than fifty
(51.6) per cent, in the actual number of
pneumonia deaths in the last over the pre-vious
decade.
Death rates of pneumonia advance enor-mously
with advancing age—roughly, in
this country from 100 in every 10,000 of
the population living between fifteen and
forty-five years, to 260 of those between
forty-five and sixty-five, and to 730 of those
over sixty-five years of age—and some part
of this Chicago increase is unquestionably
doe to the increasing age of its population.
This increase, however, is generally uniform
from one decade to another. In 1850 only
two per cent, of the population was over 60
years of age; in 1860 there was 2.6 per
cent.; in 1870, 3.2 per cent.; in 1880, 3.6
per cent., and in 1890, 3.8 per cent. The
rates of increase of this factor of the popu
lation in the successive decennial years over
the proportion in 1850 were, therefore, 30
per cent, in 1860; 60 per cent, in 1870; 80
per cent, in 1880; and 90 per cent, in
1890.t
During the thirty years 1861-1890, in-clusive,
the death rates from pneumonia
bear some relation to this rate of increase.
In the decade 1861-1870 these deaths
formed 3.9 per cent, of the total deaths
from all causes; in the two succeeding
decades they were respectively 5 and 6.7
wherever population figures are used in
this article they are those of the United States
Census in every instance—beginning with that of
1850. "Estimated population," population by
State, School or Citj' census, by directory pub-lishers,
b3' the "Two Million Club," ei al., are dis-regarded
for pre.sent purposes.
fPopulation by ages has not yet been furnished
by the Census Office for 1900.
per cent, of the total deaths. In the 1861-
70 decade they were at the rate of 92 deaths
per 100,000 of population ; in 1871-80 at
the rate of 107 and in 1881-90 at the rate of
123 per 100,000.
But in the last decade, 1891-1900, these
proportions rose t» more than ten (10.2)
per cent, of the total deaths from all causes
(as against an average of 4.4 per cent, for
the previous forty years), and to 180 (as
against a previous average of 96 for the
same period) per 100,000 of population.
Compared with the immediately preceding
decade, 1881-1890, there was an increase in
the last decade of nearly forty-six (45.9)
per cent, of pneumonia deaths in propor-tion
to population, while the increase in
the decade 1871-1880 was less than seven-teen
(16.5) per cent., and in the next decade,
1881-1890, it was less than sixteen (15.6)
per cent.
On the basis of the proportion of pneu-monia
deaths to deaths from all causes the
increase in the last decade over the previous
one is 52.2 per cent, and over the average
annual increase of the previous thirty years
it is nearlj' sixty-eight (67.8) per cent.
Obviously, the increasing pneumonia mor-tality
of the last decade is not due solely nor
chiefly to the increasing age of the popu-lation.
During this same period, 1891-1900, the
death rate of consumption, which had
steadily declined from 30.48 per 10,000 of
population in 1851-60 to 15.88 in 1881-90,
rose to 16.41 in the last decade—an increase
of 3.3 per cent. ; the bronchitis rate increased
8.4 per cent.; while the death rate from
diseases of the heart and circulatory system
increased 22 per cent.—or from 63 to 77 per
10,000 of population—and from nephritis
nearly 85 per cent., or from 32 to 59 per
10,000 population. Only the death rate
from diseases of the nervous system, out of
these five principal causes of death, shows a
BULLETIN OF THE XORTH CAROLINA BOARD OF HEALTH. 13
reduction during the last decade—to-wit:
from 27 lo 22 per 10,000 of population, a
reduction of 18 5 per cent.
The rate of reduction in the general death
rate, which had obtained during the pre-vious
forty years, also sufiered a material
check during this period. In the decade
1851-60 the average annual death rate was
35.72 per thousand; from 1861 to 1870 it
was 23.35 per thousand—a reduction of 34.6
percent.; between 1871 and 1880 the rate
was 21.16—a reduction of 9.4 percent, from
that of the previous decade; and between
1881 and 1890 the rate fell to 18.40—a fur-ther
reduction of 13 per cent. The gross re-duction
during the forty years was a little
more than 48 per cent, and the average re-duction
of each decade was 19 per cent.
But between 1891 and 1900 there were
247,240 deaths in an average annual popu-lation
of 1,399,212—an annual rate of 17.69
per thousand and a reduction of only 3.8
per cent, from the rate of the preceding dec-ade
as against a minimum reduction of 9.4
per cent, an average reduction of 19 per
cent., in the three previous decades.
In October, 1899, the fourth great pan-demic
of influenza began—"as others had
done before, in some of the distant provinces
of Russia, and by the beginning of Novem-ber
it had reached Moscow. By the middle
of November Berlin was attacked. By the
middle of December it was in London and
by the end of the month it had invaded
New York and was widely distributed over
the entire continent." Thus Osier; but
even his graphic summary fails to convey
an adequate idea of the rapidity of its
march. First heard of in Central Asia in
October, within two months it had caused
death ia Chicago and within three months
"it had reached its height in our city, at
which time (the last week in .January, 1890)
my belief is that over 100,000 of our citizens
were sufierers irom that cause alone." *
From the single influenza death in Decem-ber,
1899, the number rose to 64 in January,
1890, fell to 37 in February, rapidly
dropped to 2, 7, 1 and 1 respectively in the
next four months, after which there was a
lull until January, 1891, when there were 4
more deaths, 6 in February, 1"55 in March,
120 in April, dropping 23, 4, 1, 3, 2, 0, 2
and 16 respectively in the remaining months,
with a total of 336 influenza deaths recorded
during the year.
This actual mortality, however, very in-adequately
represents the import of epidemic
influenza to the public health. Its baleful
efi'ects in the two years are more clearly
seen in the fjllowing figures:
1889 1890 1891
Totiil deaths from all causes— lO.ylG 21 856 27.754
Rate.s per 1,00U population— 18.11 19.86 23.92
Total deaths from pneumonia— 11.70 20.73 28.98
Rates per 10,000 population.- 12.5 18.8 25.0
Total deaths from eonsumption, 14.89 19.72 21.20
Rates per 10,000 population.. 15.9 17.9 18.3
Total deaths from bronchitis.. 8.10 11.89 14.95
Rates per 10,000 population.. 8.7 10.8 12.9
The total deaths from all causes in 1891,
the second influenza year, are the highest in
number ever recorded in the history of the
city up to date, and are nearly one-third
greater in proportion to population than in
1889. The consumption death rate in-creased
15 per cent., the bronchitis rate one-half
and the pneumonia rate exactly doubled
in two years. Deaths from nephritis and
from heart diseases also markedly increased,
but not to the same extent as in the later
years of the decade.
f
*.Sivayne Wickersham, M. D., Commissioner of
Health, in .Annual Kep )rt of the Department of
Health for the year of I9iiu.
fThe permanent increase of consumption mor-tality,
also, was not marked until 1S94, the fifth
year of the influenza period. During the previous
seven years, 18S7-1S93, inclusive, the consumption
mortality formed 8.5 per cent, of the total mor-tality,
and was at the rate of 154 per 100,000 of
population. From 18;t4 to I'.IOO, inclu.'ive, it formed
9.8 per cent, of the total—an increase of 15.5 per
cent, in proportionate mortality—and was at the
rate of ISii perlO,OOOof the population, an increase
of 9 per cent, population proportion in tlie second
seven year period.
14 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
The cause of the delay in the increase of eon-sumption
mortality due to influenza, as compared
with the increase of pneumonia, is obvious. The
former disease is chronic, the later acute. Lesions
of the mucous membrane of the nose, throat and
air passages in the prevailing catarrhal bronchitis
of intiuenza and of the air cells in pneumonia per-mitted
the iavasion of the tubercle bacillus de
novo, while the characteristic prostration of the
disease and consequent impaired vital resistance
favored the development and activity of latent
bacilli already in the system. Even a mild attack
of influenza has often been the starting point of a
fata! attack of tuberculosis.
There was a marked subsidence of the
disease during 1892, in which year 103
deaths were referred to influenza—none
during the last seven months—and it was
hoped that the epidemic had ended; but
there was a recrudescence in 1893, with 88
deaths in the latter year and 51 in the
year 1898.
In the winter of 1894 95 the Commis-sioner
called attention to these facts, and
suggested that, in view of the demonstration
by Canon and Pfeiffer in 1892 of the micro-bial
origin of the disease, its bacteriologic
diagnosis was a matter of first importance,
and especially so since influenza simulated
so many other diseases. Physicians were
invited to send specimens from the throats
of suspected influenza patients to the Labora-tory
for examination and the Department
bacteriologists were requested to make a
special study of the bacillus.
Owing to the subsidence of the disease in
1896 and 1897—when there were only 17
and 15 influenza deaths resppctively—no
opportunity was aflTorded for the proposed
study and interest in the subject died out.
In the latter part of 1897, however, the
disease reappeared and 21 deaths from in-fluenza
were recorded during the month of
January, 1898. In the Department Bulletin
for that month the following statement was
published:
Verified returns for the month of January,
1898, as compared with the corresponding month
of 1897, show that there were 193 fewer deaths dur-ing
the month, the respective totals being 2,026
and 1,833. The decrease is entirely among children
under five years of age, of whom 888 died in
January a year ago and only 605 in the correspond-ing
month this year. This is a decrease of nearly
one-third. On the other hand, the deaths among
the middle-aged and beyond are in excess—an
excess caused chiefly by chronic diseases, such as
consumption, heart disease, Bright's disease, etc.,
to which must-be added 21 deaths from influenza
or la grippe, as against a total of 15 for the entire
year 1897.
Although this much-dreaded malady has not
again spread with its usual rapidity nor yet
assumed epidemic preportions in Chicago, the
Department is not entirely reassured as to its
future. It is noted that In London, Rome and in
certain places in France, where the disease has
been sporadic for some time past, it is becoming
epidemic and in some cases is assuming a gravity
which is very alarming.
These considerations led the Commissioner to
make the following statement to the public toward
the close of the month :
".\ftera period of unprecedented good health
and low death rate Chicago is threatened with an
epidemic visitation of one of the diseases most
dreaded by sanitarians. Against influenza or
grippe the preventive measures of sanitation and
public hygiene are powerless. As a recent writer
says :
' We can see it afar oft and trace its progress,
but can do nothing to stop it ; and it smites the
sanitarily pure with a severity on the whole much
the same as it shows to the rest of the world.
The Department has been anxiously watching its
progress in the city for several weeks, looping that
there might be some mistalje in the diagnosis,
since it so closely resembles some other diseases.
But this hope was swept away by the reports of
eight deaths from the 'strange and terrible
disease' during the last three days of the week
just closed (Jan. 22d). These were reported by
physicians of such eminence and experience as
to leave no room for doubt. Three of the deaths
vrere from the uncomplicated form of the disease,
but the remaining five showed the characteristic
malignant activity of the poison in fatal compli-cations
of pneumonia, apoplexy and nephritis.
"The last epidemic of this disease in Chicago
was a chief factor in increasing the total deaths
from 21,856 in 1890 to 27,754 in the epidemic year,
1891—an increase of more than one-fifth—and
numbers of the survivors have never since re-
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 15
gained their' former condition of mental and
physical health. This added terror of the disease
makes it all the more important that nothing
should be neglected which may tend to its restric-tion,
and to this end the Commissioner points out
that influenza or the 'grip' is a germ disease, and
therefore contagious. Hence the obivious thing
to do is to follow the advice of the authorities:
Keep out of the way of contagion.
The quotations that follow are from the article
Influenza in AUbutt's System of Medicine, by J. F.
Goodhart, iM. D., M. C, F. R. C. P., Physician to
Guy's Hospital, London, Eng., etc.:
•' Where strict isolation has been possible, as in
certain institutions, the disease has seldom ap-peared;
most risk of catching the disease is run
in public buildings or ill-ventilated rooms of any
sort, a street car or railway carriage with elo.sed
windows not excepted. By 'keeping out of the
way of the contagion' is meant, among other
things, avoiding close contact with one suSering
from the disease; do not sleep in the same room,
still less in the same bed, with such a sufferer, and
do not use any article or utensil in common with
such.
" It is also certain that all kinds of excesses in
living, as well as exposure and fatigue, invite at-tacks
of the disease. ' All observers have testified
to its frequency and to its heavy mortality, in the
alcoholic particularly, and also in the overworked
and harrassed.' They are further agreed that
self-dosing with so-called influenza cures and
specifics is not only useless but positively danger-ous,
and that mildness of attack and speedy re-covery
are best insured by taking to bed at once
and following the advice of a competent physi-cian.
' It is the worst folly to struggle on with
work and to attempt to fight the disease—a plan
that, although some came through successfully
(in the past epidemic), was nevertheless the
cause of the loss of many lives.' This is of
especial importance to those beyond middle age
with crippled liearts, kidneys or otlier vital organs,
" In some respects influenza resembles con-sumption
in its mode of propagation; therefore,
the same precautions with regard to the secretions
from the nose, mouth and throat should be
observed. These secretions literally teem with
the influenza bacillus and they should be im-mediately
destroyed or thoroughly disinfected
under the advice of the attending physician.
The rooms, bedding, clothing, etc., of influenza
patients should also be thoroughly disinfected
and the Department will perform such disinfec-tion
whenever notified.
"Thus far the diagnosis of influenza in Chicago
rests entirely upon the clinical .symptoms. Only
a very few specimens of the throat secretions or the
expectorate of alleged influenza patients have
been sent to the Laboratory in response to the
invitation of the Commissioner, and microscopic
examination of these has thus far failed to reveal
the presence of the Canon-Pfeitfer bacillus, in any
instance. Yet Kamen reports failing to find the
influenza germ in only one case out of a hundred
examined. The Commissioner renews his re-quest
to physicians attending influenza patients
to send specimens of the throat secretions and
expectorate of their patients either to the Main
Laboratory or to any of the sub-laboratories,
where they will be put under the microscope at
once and the result of the examination telephoned
without delay."
It was not, however, until the early part
of the following December (1898) that the
influccza bacillus was first identified in the
Department Laboratory and then only in
examinations of suspected diphtheria—no
specimens from influenza cases having been
received. Once identified the organism was
found with increasing frequency, and in the
Department Bulletin for January, 1899, Dr.
Wynekoop, Assistant Bacteriologist in
charge of bacterial diagnosis, contributed
the results of his study of upwards of a
hundred examinations and demnnstrated
the feasibility—through certain improve-ments
in technique—of the bacteriologic
diagnosis of influenza with as much cer-tainty
and as promptly as diphtheria is
diagnosed. Since that time, December, 1898,
the search for the Canon- Pfeiffer bacillus
has been as much a part of the routine of
that branch of the Laboratory work as is
the indentification of the Klebs-Loetiler, the
Eberth, the Koch, or the diplocuccus of
Class.
The germ has now been found in uncom-plicated
influenza, in bronchitis, conjunc-tivitis,
consumption, diarrheal dise.ise, diph-theria,
empyema, endocarditis, mouingitis,
nephritis, otitis media, parotitis, pneumonia,
scarlet fever, tonsillitis and whooping-cough
;
16 BULLETIN OF THE NORTH CAROLINA BOARD OP HEALTH.
and also in cases simulating cerehro-spinal
fever, lumbago, rheumatic fever and typhoid
fever.
What this pestilent organism is capable of
doing, how protean its manifestations, and
how mischievously puzzling the strictly
clinical diagnosis—may be seen in the fol-lowing:
About February 10th ult. (1899) a boy of seven
suddenly became ill with a chill, of short duration,
followed by headache and a temperature of 103.4°
F. For a number of days prior to the chill there
had been a condition closely resembling typhoid
—general languor, loss of appetite, coated tongue,
constipation, slight headache, nose-bleed and a
slight cough. The second day following the chill
the temperature rose to 105.6° F. and the pulse to
160. There were delirium, stupor and slight
convulsions—symptoms suggestive of meningitis,
but which could not be interpreted as such in the
absense of any muscular rigidity. The tempera-ture
continued near 105° F. another twenty-four
hours, when a slight erythema appeared over
parts of the body.
A coosulation was called, but a positive diagnosis
was not made. .Scarlet fever with a delayed rash
was suggested, and a hot pack ordered with the
hope of bringing out the rash should this be the
nature of the disease. The results were nega-tive.
A microscopic examination was then made
of the contents of the throat, and the presence of
great numbers of influenza bacilli was revealed.
The child was now treated for influenza with
prompt and decided improvement, the tempera-ture
falling to 102-101° F. and the pulse to 120-116.
The cough continued, however, and became more
harsh and distressing. Xo involvement of the
lungs or pleura could be discovered at this time.
During the following two weeks the typhoid
symptoms continued. Temperature varietl from
100tol03° F.; cough less pronounced; intestines
greatly distended with gas : iliac tenderness and
stools of a typhoid character. The nervous
symptoms however, were not those of typhoid,
the child being supersensitive to the touch, and
exhibiting an abnormally active mental condition.
A consulting physician was again called in, who
made a tentative diagnosis of typhoid fever com-plicated
by influenza. Widall's test was made on
several occasions, but at no time was a satisfactory
reaction obtained. What seemed to be a partial
reaction about the eighteenth day could not be
obtained later. Bacteriologic examinations were
made of the stools, and, after several attempts,
the influenza organism was isolated, which would
lead to the conclusion that this organism alone
was responsible for the intestinal symptoms. On
the tongue there were several small ulcers and
similar patches were noticed on the mucous
membrane of the lips and cheeks.
During the second week the Eustachian tubes
became affected, and later the cavities of the
middle ear. The otitis media ran the usual
course. Pus examined at the time of the rupture
of the tympanum contained the influenza bacillus,
and cultures made from the discharge revealed
the organism present in a pure condition. In
cultures examined at a later period there were
found streptococci. The intestinal symptoms dis-appeared
during the third week and the stools be-came
normal, but the temperature, which for
several days had been in the neighborhood of
100° F., began to rise a little each day, and re-spiration
became more rapid. This condition was
found to be due to an involvement of the right
pleura. Fluid began to accumulate and soon the
entire chest cavity of the affected side was filled.
Aspiration demonstrated the presence of pus.
Microscopic examinations made of the aspirated
fluid revealed the influenza organism. Small
portions of the pus were transferred to blood
serum and cultures obtained in which the bacillus
in question was found in a pure state.*
Infiuenza has, apparently, become domes-ticated
with us, and its baleful effects on the
health are sufficiently shown in the fore-going
facts and figures. Its early recognition
is the necessary first step to any restriction
of its spread—lo s?y nothing of its scientific
medical treatment. Laboratory fncilities
for such recognition are not adequately
utilized. The profession, as a whole, mani-fests
a singular indifference to the oppor-tunities
offered.
Before the recent recrudescence the ba-cillus
was detected in the Department
Laboratory in October, 1900, but it was not
until deaths from the disease bad occurred
in the following December that any demand
was made for examinations. Meanwhile, no
^Further Study of the Influenza Bacillus.
Monthly Bulletin, Department of Health : Lhieago,
March, 1899.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 17
precautions against a contagion which
spreads with almost lightning-like rapidity
were enforced. They were not enforced be-cause
the disease and, contequently, the
necessity for precautions, were' not recog-nized.
The way to fight influenza is through the
culture tube and the micrc scope.
Miiuicipal Saiiltatiou lii tlie Uiilted
States.
We have recently received frona the
author, Charles V. Chapin, M. D., Superin-tendent
of Health, Providence, R. I., a very
handsome volume of the above title of near-ly
1,000 pages, 113 illustiations, beautifully
printed on fine paper. Accompanying the
book was a note from Dr. Chapin, in which
he says: "I shall feel greatly honored if you
consider it worthy of notice in your monthly
bulletin." We are glad to say that we con-sider
it eminently "worthy of notice," for
while we have not been able to read it care-fully,
we have examined it sufficiently to note
with approval the following announcement
by the publishers, Snow and Farnham,
Providence:
"This volume deals with the practical ap-plication
of the principles of sanitary
science. It is not concerned with the theory
of sanitation, but narrates what is being
done in the United States along the lines of
public health work, and will prove of great
value to all who are interested in this sub-ject.
It is also a work of reference for
students of social science and municipal af-fairs
In this book health officials will find
answers to the questions that they are con-tinually
asking as to what is being done in
other communities. The extracts from
statutes and ordinances which have been
included, and the blank forms illustrating
public health procedures shown in the ap-pendix,
render the work unique, and one
which no health officer can afford to be
without."
A better idea of the scope of the book
can perhaps be obtained from the headings
of the fourteen chapters, which are in
order as follows: Sanitary Organizations
—
Registration of Vital Statistics—Nuisances —Specific Nuisances—Plumbing—Water,
Ice, and Sewers—Food, other than Dairy
Prod ucts—Dai ry Prod ucts—Communicable
Diseases, and one chapter entitled Legisla-tion—
Administrative Work—Disinfection,
Laboratory Work, Vaccination, Antitoxin
concluded with a consideration of hospitals
for such diseases, ambulances, quarantine
both maritime and inland—Refuse Dis-posal—
Miscellaneous Sanitary Work, which
includes among other things, diseases of ani-mals,
school hygiene, control of barbers,
prevention of blindness, nursing-bottles,
kerosene, sick poor and finances.
The special value of this publication lies
in the fact that it tells in a clear manner
how sanitary work is actually done to-day
in our country. The best way in the world
to learn how to do anything is to find out
how others who are experts in the business
do it. For that reason we cordially com-mend
it to our health officers, and especially
to our cities and towns, that those which
are already doing good sanitary work may do
better and that those which are doing prac-tically
nothing may begin and begin right.
In our judgment they could not make a
better investment than in the purchase of
" Municipal Sanitation in the United States,"
Snow and Farnhan, Publishers, Providence,
R. I. So, postpaid.
18 BULLETIN OF THE NORTH CAROLINA BOARD OP HEALTH.
Review of Diseases for April, 1901.
EIGHTY-NINE COUNTIES REPORTING.
Ninety-four counties have Superinten-dents
of Health.
Except in the case of the more conta-gious
and dangerous diseases the Super-intendent
has, as a rule, to rely upon his
own information alone, since few phy-sicians
can be induced to report cases of
non-contagious diseases to him.
Where the number of cases is not given
or the prevalence of a disease otherwise
indicated, its mere presence in the county
is to be understood as reported.
For the month of April the following
diseases have been reported from the
counties named:
Measles—Ala^iance, several cases ; Beau-fort,
4; Brunswick, many; Buncombe, 2;
Burke, many; Cabarrus, many; Caldwell, 6;
Chatham, a few; Cleveknd, many; Colum-bus,
in all parts; Currituck, 3; Gaston,
many; Gates*, a few; Granville, 8; Guilford,
3; Henderson 13; Hyde, in all parts; Jack-son,
24; Johnston, many; Lincoln, 12;
Mecklenburg, 30 ; Moore, several ; New Han-over,
36; Onslow, 75; Pasquotank, a few;
Perquimans, 40; Polk, 3; Richmond, epi-demic;
Robeson, epidemic; Rockingham;
Scotland, 1; Stanly, 12; Stokes, 5; Union,
epidemic; Wake, 8; Warren, 5; Watauga;
Yadkin, several; Yancey, many—39 counties.
Whooping COUGH —Alamance, a few;
Alexander, many; Beaufort, 3; Burke,
many; Caldwell, 10; Chatham, a few.
Chowan, several; Currituck, a few; Gra-ham,
several; Granville, 11 ; Iredell, a few ;
Johnston, many ; Lincoln, 12; Mecklenburg,
50; Mitchell, several; New Hanover, 2;
Onslow, 20; Pasquotank, a few; Perqui-mans,
15; Polk, 1; Rockingham; Scotland,
3; Stan y, 10; Surry, 4; Swain, 10; Vance,
several ; Wake, 30 ; Watauga ; Wayne, a
few; Wilson; Yadkin, general; Yancey,
many—32 counties.
Scarlet Fever—Buncombe, 1 ; Craven,
1; Davidson, 7; Guilford, 1; Mecklenburg,
20; New Hanover, 2; Rockingham 1—
7
counties.
Diphtheria—Cabarrus, 1; Davie, 4;
Franklin, 1 ; Richmond, 2—4 counties.
Typhoid Fever—Clay, 1 ; Harnett, a
few; Jackson, 1; Johnston, 1; Madison, 4;
Onslow, 1 ; Orange, 1 ; Polk, 1 ; Robeson ;
Rockingham; Stanly, 4; Swain, 1; Union,
2; Vance, a few; Yancey, 1—15 counties.
Malarial Fever—Cabarrus ; Craven
;
Guilford; Iredell; Lenoir; New Hanover;
Onslow; Orange, a few; Perquimans, in all
parts; Rockingham; Wayne—11 counties.
Malarial Fever—
H
emorrhagi
c
—
Cabarrus, 1; Craven, 1; Onslow, 1.
Influenza—Alleghany; Ashe; Cabar-rus,
a few; Catawba; Chatham, a few;
Cleveland, a few; Currituck, a few; Duplin;
Gaston, a few; Graham; Greene, in all
pans; Jackson; McDowell; Madison, in all
parts; Mitchell; Person, a few; Richmond;
Robeson; Sampson; Stokes; Transylvania;
Union ; V/arren—2S counties.
Bowel Diseases—Harnett; New Han-over;
Scotland.
Hydrophobia—Alleghany, 1, a child,
died seven weeks after being bitten.
Meningitis—Jackson, 1.
Mumps—Alarciance; Cabarrus, a few;
Columbus, in all parts; Gaston, many ; Guil-ford;
Lincoln, in all parts ; Wayne—7 coun-ties.
Pneumonia—Alleghany; Currituck, 2;
Franklin, 3 or 4; Graham, several; Gran-ville,
in many parts; Greene, in all parts;
Lenoir; Madison, in all parts; Mitchell;
Perquimans, 8; Person, a few; Robeson;
Scotland; Swain; Union; Warren; Yad-kin—
17 counties.
Rheumatism—Mitchell.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH, 19
Varicella—Cherokee, 8 or 10 ; McDow-ell;
Wilson.
Small-pox—Buncombe, 23; Cabarrus, 5;
Caswell, 9; Chatham, 13; Cleveland, 2;
Davidson, 10; Durham, 27; Forsyth, 1,
death; Greene, 6; Guilford, 23, last case
now discharged ; Halifax, 2, none now
;
Johnston, 15; Mecklenburg, 20, one at
present; Nash, 1; Orange, 6; Person, 8;
Polk, 2; Robeson, 2; Rockingham, 1;
Stanly, 3; Wake, 28—21 counties.
Cholera in Chickens—Perquimans;
Rockingham.
Cholera in Hogs—Ashe; Bertie;
Chowan; Lenoir.
Distemper in Horses—Burke; Cleve-land
; Graham ; Swain.
Hydrophobia, in Dogs—Brunswick,
Pink-eye in Horses—Wilkes.
No diseases reported from Bladen, Car-teret,
Dare, Edgecombe, Haywood, Jones,
Northampton, Pitt, Randolph, Rowan, Ruth-erford
and Washington.
No reports received from Anson, Cum-berland,
Hertford, Montgomery and Pender.
Sitininary of Mortnary Reports for
April, 1901.
(twenty-four towns).
Only those towns from which certified
reports are received are included.
Aggregate popula- White. Col'd. Total.
tion 77,594 47,367 124,961
Aggregate deaths... 77 87 164
Representing tem-porary
annual
death rate per
1,000 11.9 22.0 14.2
Causes of Death.
Malarial fever 1 1 2
Whooping-cough ..0 1 1
Measles .' 10 1
Pneumonia 10 12 22
Consumption 10 14 24
Brain diseases 6 6 12
Heart diseases 7 5 12
Neurotic diseases... 3 3
Diarrhoeal diseases 3 8 11
All other diseases.. 36 34 70
Accident 2 3 5
Violence 1 1
77 87 164
Deaths under five
years 27 18 45
Still-born - 4 6 10
20 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
mortuary Report for April, 1901.
Towns
AND Reporters.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 21
County Superintendents of Health.
Alamance Dr. T. S. Faucette.
Alexander Dr. T. F. Stevenson.
Alleghany Dr. B. C. Waddell.
Anson Dr. E. S. Ashe.
Ashe Dr. Manley Blevins.
Beaufort Dr. P. A. Nicholson.
Bertie Dr. H. V. Dunstan.
Bladen Dr. Newton Robinson.
Brunswick Dr. J. A. McNeill.
Buncombe Dr. James Sawyer.
Burke Dr. J. L. Laxton.
Cabarrus Dr. D. G. Caldwell.
Caldwell Dr. A. A. Kent.
Camden
Carteret Dr. F. M. Clark.
Caswell Dr. S. A. Malloy.
Catawba Dr. Geo. H. West.
Chatham Dr. H. T. Chapin.
Cherokee Dr. J. F. Abernathy.
Chowan Dr. T. J. Hoskins.
Clav Dr. J. M. Sullivan.
Cleveland Dr. B. H. Palmer.
Columbus Di'. I. Jackson.
Craven Dr. R. DuVal Jones.
Cumberland Dr. J.Vance McGougan.
Currituck Dr. H. M. Shaw.
Dare Dr. W. B. Fearing.
Davidson Dr. Joel Hill.
Davie Dr. James McGuire.
Duplin Dr. James W. Blount.
Durham Dr. Z. T.Brooks.
Edgecombe Dr. L. L. Staton.
Forsvth Dr. John Bynum.
Franklin Dr. E. S. Foster.
Gaston Dr. J. H. Jenkins.
Gates Dr. W. 0. P. Lee.
Graham Dr. R. J. Orr.
Granville Dr. S. D. Booth.
Greene Dr. Joseph E. Grimsley.
Guilford Dr. Edmund Harrison.
Halifax Dr. I. E. Green.
Harnett Dr. O. L. Denning.
Haywood Dr. F. M. Davis.
Henderson Dr. J. G. Waldrop.
Hertford Dr. John W. Tayloe.
Hyde Dr. E. H. Jones.
Iredell Dr. Henry F. Long.
Jackson Dr. Wm. Self.
Johnston Dr. L. D. Wharton.
Jones Dr. S. E. Koonce.
Lenoir Dr. W. T. Parrott.
Lincoln Dr. T. F. Costner.
McDowell Dr. B. A. Cheek.
Macon Dr. F. L. Siler.
Madison Dr. Jas. K. Hardwicke.
Martin Dr. W. H. Harrell.
Mecklenburg Dr. F. M. Winchester.
Mitchell Dr. V. R. Butt.
Montgomery Dr. M. P. Blair.
Moore Dr. Gilbert McLeod.
Nash Dr. J. P. Battle.
New Hanover Dr. W. D. McMillan.
Northampton Dr. H. W. Lewis.
Onslow Dr. E. L. Cox.
Orange Dr. C. D. Jones.
Pamlico
Pasquotank Dr. H. T. Aydlett.
Pender Dr. L. L. Ardrey.
Perquimans Dr. C. C. Winslow.
Person Dr. J. A. Wise.
Pitt Dr. C. O'H. Laughing-house.
Polk Dr. Earle Grady.
Randolph Dr. T. T. Ferree.
Richmond Dr. J. M. Ledbetter.
Robeson Dr. H. T. Pope.
Rockingham Dr. Sam Ellington.
Rowan Dr. W. L. Crump.
Rutherford Dr. W. A. Thompson.
Sampson Dr. R. E. Lee.
Scotland Dr. A. W. Hamer.
Stanly Dr. V. A. Whitley.
Stokes Dr. W. V. McCanless.
Surry Dr. John R. Woltz.
Swain. Dr. J. A. Cooper.
Transylvania Dr. C. W. Hunt.
Tyrrell
Union Dr. J. E. Ashcraft.
Vance Dr. Goode Cheatham.
Wake Dr. J. J. L. McCullers.
Warren Dr. A. S. Pendleton.
Washington Dr. W. H. Ward.
Watauga Dr. E. F. Bingham.
Wayne Dr. Williams Spicer.
Wilkes Dr J. M. Turner.
Wilson Dr. W. S. Anderson.
Yadkin Dr. S. L. Russell.
Yancey Dr. W. M. Austin.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 23
[You are asked to fill out and mail one of these forms to the Superintendent of Health of your
county on or before the third of each month, that he may use it in making his report to the Secretary
of the State Board.
Have any of the following diseases occurred in your practice during the month
just closed. If so, state number of cases.
Whooping-cough Tj^phoid Fever
Measles Typhus Fever
Diphtheria Yellow Fever
Scarlet Fever Cholera
Pernicious Malarial Fever Smallpox
Hemorrhagic Malarial Fever Cerebro-spinal Meningitis
What have been the prevailing diseases in your practice ?
Has any epidemic occurred among domestic animals? If so, what?
What is the sanitary condition of your section, public and private?
General Remarks:
M. p.
.190-— N. C.
:B"criL-i^E3i:i2:T
OF THE
North Carolina Board of Health.
Published Monthly at the Office of the Secretary of the Board, Raleigh, N. C
Geo. G. Thomas, M. D., Prfs., Wilmington.
S. Westeay Battle, M. D...Asheville.
Hentjy W. Lewis, M. D Jackson.
J. L. Nicholson, M. D Richlands.
W. P. IvEY, M. D Lenoir.
Francis Duffy, M. D New Bern.
W. H. Whitehead, M. D Rocky Mt.
J. L. TiUDLOw, C. E Winston.
Richard H. Lewis, M. D., Secretary and Treasurer, Raleigh.
Vol. XVI. JUNE, 1901. No. 3.
Tlie Meeting of tbe Board.
The annual meeting of the Board oc-curred,
as required by law, at the same
time and place as that of the State Medical
Society, May 21-22, at Durham. All the
members were present. Doctors Thomas
and Lewis were re-elected President and
Secretary, respectively. The Secretary re-ported
oflBcially the favorable action of the
State Board of Agriculture on the request to
have bacteriological analyses of suspected
drinking water made in their biological
laboratory, and the following resolution
was adopted :
Whereas, the State Board of Agricul-ture
responded favorably to the request of
the State Board of Health made at its last
annual meeting to provide in its biological
laboratory for the free bacteriological ex-amination
of drinking waters suspected of
conveying disease, especially typhoid fever;
and
Whereas, the work of this kind already
done shows even thus early its great value
to the people, actual and prospective; now,
therefore, be it
Resolved, That the State Board of
Health desires to put on record its appre-ciation
of this additional evidence of the
progressive and enlightened spirit displayed
by the State Board of Agriculture in its
work and to express its belief that the ex-penditure
for this purpose will be returned
many fold to the people of the State in the
saving of many valuable lives and great
loss of time from long illnesses and in the
education of the people as to the importance
and value of sanitation.
In compliance with the act of the last
Legislature creating a State Board of Em-balmers,
to be "appointed by the State
Board of Health, three of whom shall be
members of the State Board of Health, the
remaining two shall be practical embalm-ers,"
etc., Messrs. J. W. Harry, of Char-
26 BULLETIN OP THE NORTH CAROLINA BOARD OF HEALTH,
lotte, and H. W. Simpson, of New Bern,
practical embalmers, were elected for five
and four years, and Drs. Battle, Duffy
and Lewis, R. H., for three, two and
one years, respectively. This Board is
to meet for organization on July second.
A committee of three, composed of Henry
W. Lewis, M. D., J. L. Ludlow, C. E.,
and the Secretary, was appointed to prepare
a new edition of the "Instructions for
Quarantine and Disinfection."
The Treasurer made his annual report
and Drs. Ivey and Duffy were appointed a
committee to audit the same. They re-ported
it correct.
The CoD-joint Session with the State
Medical Society assembled, as usual, at 12 m.,
Wednesday. The Secretary read his report
which is appended. Following this was
quite an animated discussion upon the true
character of a disease which had prevailed
extensively in Wilson county, and about
which there was a difference of opinion be-tween
the Superintendent of Health of the
county on the one side and the State Small-pox
Inspector and a member of the State
Board of Health |on the other—the first
claiming it to be chicken-pox and the last
two small-pox. Unfortunately neither of
the last two gentlemen were present but the
general sentiment was all against the chick-en-
pox theory. We hope it may have been
chicken-pox and that nothing will be heard
from it next winter, but we must say we feel
very anxious about it.
The term of office of the four members
elected by the Society having expired.
Doctors S. Westray Battle, of Asheville, and
Henry W. Lewis, of Jackson, were elected
for the term of six years, to succeed them-selves,
and Doctors J. L. Xicholson, of
Kichlands, and W. H. Whitehead, of Rocky
Mount, for the term of four years.
The following is the report of tljc Secre-tary
:
ANNUAL REPORT OF THE SECRETARY.
The past year has been marked by greater
progress in our efforts to protect the public
health than any equal period in the history
of the Board. Our work in trying to edu-cate
the public mind up to the importance
and value of sanitation in its various forms
is beginning to tell. The evidence of this
is seen in the provision made by the Depart-ment
of Agriculture for the free biological
analyses of suspected drinking waters, in
addition to the chemical analyses it has been
making for years; in the valuable amend-ments
to our health law made by the last
Legislature—and made not grudgingly but
in a liberal and enlightened spirit; in the
enactment of a law regulating the embalm-ing
of dead bodies; in the increase in the
number of public water supplies—eight, or
thirty-three per cent, actually, and many
more prospectively ; and in the greater in-terest
taken by the people generally in such
matters.
The full report of the work of the Board
in detail from our last meeting at Tarboro
to January 1, 1901, will be found in the
Eighth Biennial Report, a copy of which
will be gladly mailed to any one desiring it,
and to which those interested are referred.
WATER ANALYSES.
The value of a bacteriological examination
in locating the cause of typhoid fever in
contaminated or infected drinking water is
now thoroughly established. There are
probably from eight to ten thousand cases
of typhoid fever in the State every year.
In very many instances a number of cases
following one another at longer or shorter
intervals have their origin in a common
infected well or spring. If the drinking
water supply of the first case should be
jrromptly examined bactericlogically, and the
fact of its infection demonstrated, a number
of the latter cases could be prevented.
BULLETIN OF THE NORTH CAROLINA BOARD OP HEALTH. 27
Kealizing this and deslrinsj to bring it di-rectly
to the attention of the profession, to-gether
wich the fact that the examination
could be obtained free of charge, I mailed
to every physician in the State the following
letter, in addition to publishing essentially
the same thing in The Bulletin, which
they also received
:
Raleigh, N. C, January 20, 1901.
My dear Doctor.-^—^As you will have
noticed in The Bulletin for December,
mailed you the first of the month, the State
Agricultural Department has made provis-ion
for the bacteriological examination of
drinking waters suspected of carrying dis-ease.
Since the article in The Bulletin
was written the Honorable Commissioner of
Agriculture has ruled that all applications
for such analysis must be made to the Sec-retary
of the State Board of Health, and
approved by him before the work will be
done, for the purpose of guarding his labo-ratory
against too numerous applications
based on mere curiosity. As the county
superintendent of health is the recognized
health officer of every county, application
should first be made to him, giving the rea-sons
for suspecting the water, with request
that he approve and forward to me, and upon
receipt I will, if satisfied as to the necessity
for the analysis, forward permit direct to
you. In urgent cases, application may be
made direct to me.
Whenever a case of undoubted typhoid
fever occurs in a family, their drinking
water should be analyzed bacteriologically
as soon as possible. By promptly having
this done, many cases of that disease would
be prevented. So, if you have any cases of
typhoid fever in your practice, send for per-mit,
stating in your application the number
of cases and the conditions.
Very truly yours,
Richard H. Lewis,
Secretary.
My efforts in this direction have, I regret
to say, borne but little fruit, only thirteen
applications for analysis having been made
by physicians in nearly four months. The
indifference of the profession in this matter
I find it difficult to explain, for while it is the
duty of the physician to cure diseases, it is
none the less his dutj' to prevent it when he
can—as all worthy of their calling will, of
course, admit. If we do not avail ourselves
of the privilege offered us it will, I fear, be
withdrawn. Unless the value to the people
of the State of this work can be demonstrated
to the satisfaction of the Board of Agri-culture
it will surely be discontinued, and
when it is too late we will realize what we
have lost. I hope, therefore, every one who
hears or reads this will make it an invaria-ble
rule in every case of typhoid fever, im-mediately
upon making the diagnosis, to
write me for a permit and a sterilized bottle.
While, in the letter, in order to show proper
respect for the office of county superintend-ent
of health and perhaps protect the De-partment
of Agriculture from occasional
unnecessary work, I made it a condition of
the issuance of the permit that the applica-tion,
except in urgent cases, should first be
made to that official, who would approve and
transmit to me, I have since abandoned it as
being cumbersome and promotive of delay.
As a matter of fact all these cases are urgent
cases, and a direct application to me will
secure the permit and bottle at once.
LEGISLATION.
Realizing from our experience in the man-agement
of small-pox during the past three
years that our law of 1893 was defective in
a certain vagueness as to tlie duties and
powers of county authorities in matters per-taining
to the public health, I prepared and
secured the passage by the General Assem-bly
of the act amendatory thereto given
below. This was done, I am glad to say,
without difficulty, as was to have been ex-pected
of a body of men of such intelligence
and character as those composing the recent
Legislature. Although nearly all the mem-bers
supported the bill, 1 feel that special
acknowledgment should be made to Sena-tors
Justice and Henderson, o£ the Judiciary
28 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Committee, for legal advice, and to Dr.
Speight, of Edgecombe, in the Senate, and
Dr. Stevenson, of Iredell, in the House, for
valuable aid.
The following is the act
:
AN ACT TO AMEND AN ACT RELATING TO
THE BOARD OF HEALTH, CHAPTER 214,
LAWS OF 1893.
The General Assembly of North Carolina do
enact:
Section 1. That section 2 of chapter 214,
Laws of 1893, be amended by striking out
in line two the words "two years" and in-serting
in lieu thereof the following: "two
for four years and two for six years and
their successors for six years," and by strik-ing
out in line five the words "two years"
and inserting in lieu thereof the following:
"one for two years, two for four years and
two for six years and their successors for six
years."
Sec 2. That section 4 be amended by
striking out in lines three and four respect-ively
the word "two" and inserting in lieu
thereof the word "six."
Sec 3. That section 5, as amended by
chapter 201, Laws of 1897, be stricken out
and the following substituted therefor :
"Section 5. There shall be an auxiliary
board of health in each county in the State,
whose function shall be, upon the call of the
chairman of the board of county commis-sioners,
to advise the county authorities in
all matters pertaining to the public health.
These boards shall be composed of all regis-tered
physicians resident in the county.
From this board two physicians, shall be
selected, one by the chairman of the board
of county commissioners and one by the
mayor of the county town, who, together
with the board of county commissioners,
shall constitute the county sanitary com-mittee,
of which committee the chairman of
the board of county commissioners shall be
ex officio chairman. Their term of office
shall be conterminous with that of the com-missioners
with whom they serve, and when
on duty they shall receive the same com-pensation
as is received by the county
commissioners. The county sanitary com-mittee
shall have the immediate care and
responsibility of the health interests of
their county. They shall make such rules
and regulations, pay such fees and salaries
and impose such penalties as in their judg-ment
may be necessary to protect and ad-vance
the public health. And any person
violating such rules and regulations shall
be guilty of a misdemeanor and may be
fined not exceeding fifty dollars or impris-oned
not exceeding thirty days. They
shall elect a registered physician, not a
member of the sanitary committee, to serve
two years, with the title of county superin-tendent
of health, and shall fix his compen-sation.
The duty of the county superinten-dent
of health shall be to carry out as far as
possible such work as may be directed by
the county sanitary committee and by the
State Board of Health. He shall always
promptly advise the Secretary of the State
Board of Health of the unusual prevalence
of disease in his county, especially of ty-phoid
fever, scarlet fever, diphtheria, yel-low
fever, small-pox and cholera. He shall
make the medico-legal post-mortem exam-inations
for coroners' inquests, attend the
inmates of the home for the aged and in-firm
and the prisoners in the jail or convict
camp of his county, and make exalminations
of lunatics for commitment. He shall be
the sanitary inspector of the home and jail,
including convict camps, of his county,
making monthly reports to the county com-missioners
and to the Secretary of the State
Board of Health."
Sec. 4. That section 8 be stricken out
and the following substituted therefor
:
"The meeting of the State Board of Health
for the election of officers shall be on the
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 29
second day of the annual meeting of the Med-ical
Society of the State of North Carolina in
1901, and every six years thereafter; and of
the county sanitary committee for the elec-tion
of a county superintendent of health on
the first Monday in May, 1901, and every
two years thereafter."
Sec. 5. That section 14 be amended by
inserting after the word "commissioners" in
line five the words "or county sanitary com-mittee."
Sec. 6 That section 15 be amended by
inserting between the words "town" and
"near" at the end of line two the words "or
the sanitary committee of a county"; by
striking out after the word "town" in line
fourteen the words " or county board of
health " and inserting in lieu thereof the
words "board of health or county sanitary
committee;" and by striking out after the
word "town" in line twenty-one the words
"or county board of health" and inserting ,
in lieu thereof the words "board of health
or county sanitary committee."
Sec. 7. That section 23 be amended by
striking out all of said section from tlie be-ginning
of line ten and inserting in lieu
thereof the following: "the sanitary com-mittee
of any county may make such regu-lations
and provisions for the vaccination of
its inhabitants and impose such penalties as
they may deem necessary to protect the
public health ; and any person violating
such regulations shall be guilty of a misde-meanor
and may be fined not exceeding
fifty dollars or imprisoned not exceeding
thirty days."
Sec. 8. That section 25 be amended by
adding thereto the following: "And any
person violating such regulations shall be
guilty of a misdemeanor and may be fined
not exceeding fifty dollars or imprisoned
not exceeding thirty days."
Sec. 9. That section 7 having been re-pealed
the number of section 8 be changed to 7
and of all subsequent sections in accordance
therewith.
Sec. 10. That this act shall be in force
from and after its ratification.
It will be seen that, stated in a few words,
to quote from the editorial comments thereon
in The Bulletin for February, these
amendments "consist essentially: In in-creasing
the term of members of the State
Board of Health from two years, all expiring
at the same time, to six years, so arranged
as to expire at different times, thereby as-suring
a continuing board; in the creation
of a "county sanitary committee," com-posed
of the board of county commissioners
and two physicians and endowed with defi-nite
responsibilities and powers; and in re-storing
the term of oflice of county superin-tendent
of health from one to two years.
Our law has always been defective in not
providing proper machinery for its admin-istration
by counties. That defect is now
remedied as satisfactorily, we think, as the .
conditions obtaining in our State will per-mit.
It will also be noted that the medical
profession is recognized as far as practicable,
and this we hope will revive their interest
in sanitary matters. It is true that the con-trol
remains in the hands of the board of
county commissioners, as they will always
be in a majority, but in all matters pertain-ing
to the public health, including the elec"
tion of a county superintendent of health,
two physicians will have a voice."
It also appears that the State Medical
Society must at this meeting elect two mem-bers
to serve for six years, and two for four
years, with the f >llowing members appointed
by His Excellency, Governor Aycock, viz.:
Drs. W. P. Ivey and Richard H. Lewis for
six years, Drs. George G. Thomas and
Francis Dufiy for four years, and Mr. J. L.
Ludlow, C. E., for two years.
In order that there might be no miscar-riage
in the organization of thecountv sani-
30 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
tary committees, I addressed a letter on
March 2d to every board of county commis-sioners
calling their attention to the amended
laws, at the same time mailing them a copy,
and again on March 28th I wrote to the
chairman of every board and to the mayor
of every county town, reminding them of the
duty imposed upon them of each appointing a
physician to serve as a member of the county
sanitary committee. Although I specially
requested that I should be notified of the
appointments and enclosed a postal card for
reply, there are still a number of counties
and towns to be heard from, and it is there-fore
impossible to say how many county
sanitary committees have been properly or-ganized.
The first fruits of this creation of practi-cally
a county board of health was shown
in a request from the committee of Guilford
county to your Secretary to visit Greensboro
and advise with them as to the probable
cause of much malarial fever just north of
the city in recent yeais, and the best means
of removing it ; and in a similar request
from the committee of the county of Dur-ham
to go to Durham and advise with them
as to the best management of the small-pox
which had gained a foot-hold in the county.
I complied with both requests.
SMALL- POX.
The history of small-pox in the State
during the past year is practically a repeti-tion
of that for the preceding two years,
although the number of cases is nearly one
thousand less, being 1,945 against 2,806 for
the year 1899-1900, of whom 530 were white
and 1,415 colored—a somewhat larger pro-portion
of whites than heretofore. The
death-rate has also been lower, 2.83 per cent,
for the whites against 4.78 per cent., and
1.63 per cent, for the colored against 1.44
per cent; total 1.95 per cent, against 2.31
per cent. This decrease is probably due to
the vaccination of a considerable proportion
of the people through the influence of pre-vious
scares, for otherwise a reasonable ex-pectation
was that there would be more
cases instead of fewer. This explanation is
rendered more probable by the fact that this
last year the disease has prevailed chiefly in
the country districts where vaccination has
not been practised as it has been in the cities
and towns, centres of population and trade.
Some time since I received from a friend
a copy of a poster illustrated with pictures
of cases of small-pox, and containing the
announcement, " vaccine sold here," which
he had picked up in Tennessee, and which
was accompanied by a letter suggesting that
they might be made useful in this State. It
revived a suggestion I made to the Board
several years ago to placard the State with
the simple rules of health, and immediately
appealed to me, so I wrote the Mulford Com-pany
asking if they could furnish me with
similar posters signed by the Board, and at
what price. In response they kindly sent
me several thousand in the form desired
without charge. I have distributed them in
a number of counties where small-pox was
prevailing and they seem to have been of
service. The man who would "rather have
small-pox than be vaccinated" stops talking
after seeing the pictures. The small-pox
inspectors, whose reports are attached, have
continued to be of much service, Governor
Aycock having given his consent to their
employment, as required by the section of
the law making a spec'al appropriation for
use when rendered necessary bv pestilential
disease. In tabulated form the small-pox
statement is as follows:
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
SMALL-POX IN NORTH CAROLINA, MAY 1, 1900, TO MAY 1, 1901.
31
Counties.
32 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
The county of Wilson has been omitted
from the foregoing table for the reason that
the figures could not be obtained from the
County Superintendent of Health because,
in his opinion, there has been no small-pox.
In his reply to my letter asking for his re-port
on sm'all-pox for the year he writes:
"Our discussion to-day before our County
Society was the eruptive disease that has
prevailed in this county for the past three
months, and it was the unanimous opinion
that it is not small-pox. I suppose there
have been 500 cases in the town and county
and only one death, and that in an old man
who was sick with la grippe nine days before
he broke out."
On the other hand the small- pox inspector
for that section of the State, who was sent to
the county at the request of a member of
the State Board of Health living there says
the disease was small-pox and two of the
leading physicians of the county in a letter
to the inspector dated May 11, 1901, says :
"We believe there has been small-pox in the
county in the practice of other physicians,
and we know there are cases of small-pox
we have seen."
The above is a simple statement of the
facts in the possession of the Secretary and
the candid reader can draw his own conclu-sions,
relying in doing so on the good char-acter
and sincerity of all the parties to the
controversy.
In conclusion, it is safe to say that we
are justified in feeling encouraged, and with
the more active support from the profession
at large still greater progress is in reach.
Revle^v of Diseases for May, 1901.
NINETY-ONE COUNTIES REPORTING.
Ninety-four counties have Superinten-dents
of Health.
Except in the case of the more conta-gious
and dangerous diseases the Super-intendent
has, as a rule, to rely upon his
own information alone, since few phy-sicians
can be induced to report cases of
non-contagious diseases to him.
Where the number of cases is not given
or the prevalence of a disease otherwise
indicated, its mere presence in the county
is to be understood as reported.
For the month of May the following
diseases have been reported from the
counties named:
Measles.—Alamance, 68 cases; Anson;
Ashe, 10; Beaufort, 2; Bladen, a few; Bruns-wick,
a great many; Cabarrus, 2; Caldwell,
20; Carteret; Chatham, 1; Columbus, a few;
Cumberland, a few ; Currituck, a few ; David-son,
several; Graham, several; Granville,
3; Guilford, 3; Henderson, 22; Hyde, 4;
Jackson, 25; Lincoln, 10; Macon, 3; Mont-gomery,
4; Moore, several; New Hanover,
21; Onslow, 20; Pasquotank, 2; Pender, a
few; Perquimans, 40; Polk, 1 ; Randolph, a
great many; Richmond, 20; Robeson, epi-demic;
Rowan, 30; Stanly; Stokes, 3; Swain,
a few; Wake, 69; Watauga, 20; Yadkin,
general ; Yancey, many—41 counties.
Whooping-cough.—Alamance, 47; Alex-ander,
epidemic; Beaufort, 2; Cabarrus, 12;
Caldwell, 10; Chatham, many; Chowan,
many; Craven, 2; Cumberland, a few; Cur-rituck,
a few; Davidson, several; Durham,
20; Granville, 8; Henderson, general;
Johnston, many ; Lincoln, 12; Mecklenburg,
20; Montgomery, 3; Moore, several; New
Hanover, 5; Pasquotank, 2; Pender, a few;
Person, 8; Polk, 15; Randolph, general;
Rockingham; Rutherford, a few; Scotland,
10; Stanly; Vance, epidemic; Wake, 27;
Watauga, a few; Wayne, a few; Wilson, a
few; Yadkin, general; Yancy, many—36
counties.
Scarlet Fever.—Buncombe, 4; David-son,
6; Greene, 3; Iredell, 1; Mecklenburg,
5 or 6; Rockingham, 2; Rowan, 1—
7
counties.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 33
Diphtheria.—Cabarrus, 2; Cleveland, 1;
Davie, 1; Granville, 20; Macon 1; Rocking-ham,
1 ; Wake, 1—7 counties.
Typhoid Fever.—Cabarrus, 2; Caldwell
3; Chatham, 6; Chowan, 1; Clay, 2; Colum
bus, 2; Craven, 2; Durham, 2; Granville, 1
Harnett, a few ; Iredell, 1 ; Jones, 2 ; Me
Dowell, 4; Macon, 2; Madison, 1; Mont
gomery, 2; New Hanover, 2; Onslow, 4
Pasquotank, 4; Pender, 1; Perquimans
2; Person, 1; Polk, 2; Randolph, 4; Robe
son; Rockingham, a few; Rowan, 2; Ruth
erford, 1 or 2; Sampson, a few; Scotland, 4
Stanly, in all parts; Surry 2; Union, 10
Vance, several ; Wake, 2—35 counties.
Malarial Fever.—Brunswick ; Cas-well;
Chowan; Cumberland; Currituck;
Duplin; Greene; Guilford; Halifax; Hyde;
Onslow; Orange; Pasquotank; Perquimans;
Person ; Warren—16 counties.
Malaria Fever, Hemorrhagic.—Cho-wan,
1 ; Perquimans, 1.
Malarial Fever, Pernicious.—Hyde.
Diarrhceal Diseases, Including Dys-entery.—
Alexander, general; Alleghany;
Anson, general; Ashe; Bertie; Burke; Cald-well;
Catawba; Cleveland; Columbus;
Craven; Duplin; Franklin; Gaston; Gran-ville;
Greene, general; Halifax; Harnett;
Haywood ; Henderson ; Hertford ; Iredell,
general; Lenoir; Lincoln, general; Mc-
Dowell; Macon; Martin, general; Moore,
general ; New Hanover, general ; Northamp-ton,
general; Onslow, general; Pasquotank;
Pender, general ; Perquimans ; Person ; Polk
;
Randolph; Richmond; Robeson, general;
Rockingham; Scotland; Stanly, general:
Stokes ; Surry, general ; Swain ; Transyl-vania;
Union, general. Wake; Watauga,
general ; Wayne—50 counties.
Influenza.—Craven, mild, in all parts.
Pneumonia.—Anson; Clay; Haywood;
Warren.
Varicella.—Caswell.
Small-pox.—Buncombe, 17; Cabarrus, 7
;
Caswell, 12; Chatham, 4; Cleveland, 8;
Cumberland, 20; Durham, 10; Gaston, 6;
Greene, 2; Guilford, 4; Johnston, 19; Meck-lenburg,
15; Orange, 10; Person, 29; Polk,
2; Robeson, 2; Rockingham, 2 ; Rowan, 2;
Stanly, 2; Wake, 12; Wayne, several—20
counties.
Black-LEG in Calves.—Ashe.
Cholera in Chickens.—Scotland.
Cholera in Hogs.—Ashe; Bertie; Hyde;
Robeson.
Distemper in Horses.—Alexander;
Burke; Graham; Yancy.
No disease reported from Dare, Edge-combe,
Forsyth, Gates, Mitchell, Nash and
Washington.
No reports received from Cherokee, Pitt
and Wilkes.
Snmniarj' of Mortuary Reports for
May, 1901.
(twenty-four towns).
Only those towns from which certified
reports are received are included.
Aggregate popula- WJiite. Col'd. Total.
tion : 72,928 45,752 118,680
Aggregate deaths... 103 9fl 202
Representing tem-porary
annual
death rate per
1,000 16.9 26.0 20.4
Causes of Death.
Typhoid Fever.' 10 1
Malarial fever 1 -6 7
Whooping-cough ..3 1 4
Measles 10 1
Pneumonia 10 12 22
Consumption 7 5 12
Brain diseases 8 8
Heart diseases 8 9 17
Neurotic diseases... 14 5
Diarrhoeal diseases 17 12 29
All other diseases.. 44 47 91
Accident 12 3
Violence 112
103 99 202
Deaths under five
years 36 35 71
Still-born 12 8 2o
34 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Mortuary Report for may, 1901.
Towns
AND EePOBTEES.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 35
County Superintendents of Healtli.
Alamance Dr. H. R. Moore.
Alexander Dr. C. J. Carson.
Alleghany Dr. B. C. Waddell.
Anson Dr. J. H. Bennett.
Ashe Dr. J. W. Calvard.
Beaufort Dr. Jno. G. Blount.
Bertie Dr. H. Y. Dunstan.
Bladen Dr. Newton Robinson.
Brunswick Dr. J. A. McNeill.
Buncombe Dr. James Sawyer.
Burke Dr. J. L. Laxton.
Cabarrus Dr. R. S. Young.
Caldwell Dr. A. A. Kent.
Camden
Carteret Dr. F. M. Clark.
Caswell Dr. S. A. Malloy.
Catawba Dr. Geo. H. West.
Chatham Dr. H. T. Chapin
Cherokee Dr. J. F. Abernathy.
Chowan Dr. T. J. Hoskins.
Clav Dr. J. 0. Nichols.
Cleveland Dr. B. H. Palmer.
Columbus Dr. I. Jackson.
Craven Dr.W. H. Street.
Cumberland Dr. Jno. D. McRae.
Currituck Dr. H. M. Shaw.
Dare .Dr. W. B. Fearing.
Davidson Dr. Joel Hill.
Davie Dr. James McGuire.
Duplin Dr. O. F. Smith.
Durham Dr. N. M. Johnson.
Edgecombe Dr. L. L. Staton.
Forsyth Dr. John Bynum.
Franklin Dr. E. S. Foster.
Gaston Dr. J. H. Jenkins.
Gates Dr. W. O. P. Lee.
Graham j....Dr. R. J. Orr.
Granville Dr. S. D. Booth.
Greene Dr. Joseph E. Grimsley.
Guilford Dr. Edmund Harrison.
Halifax Dr. I. E. Green.
Harnett Dr. 0. L. Denning.
Haywood Dr. S. B. Metford.
Henderson Dr. J. G. Waldrop.
Hertford Dr. John W. Tayloe.
Hyde Dr. E. H. Jones.
Iredell Dr. Henry F. Long.
Jackson Dr. Wm. Self.
Johnston Dr. L. D. Wharjon.
Jones Dr. S. E. Koonce.
Lenoir Dr. Raymond Pollock.
Lincoln Dr. T. F. Costner.
McDowell Dr. B. A. Cheek.
Macon Dr. F. L. Siler.
Madison Dr. Jas. K. Hardwicke,
Martin Dr. W. H. Harrell.
Mecklenburg Dr. C. S. McLaughlin.
Mitchell., Dr. Y. R. Butt.
Montgomery Dr. M. P. Blair.
Moore Dr. Gilbert McLeod.
Nash Dr. J. P. Battle.
New Hanover Dr. W. D. McMillan.
Northampton Dr. H. W. Lewis.
Onslow Dr. E. L. Cox.
Orange Dr. D. C. Parris.
Pamlico
Pasquotank Dr. H. T. Aydlett.
Pender Dr. J. R. Thomson.
Perquimans Dr. C. C. Winslow.
Person Dr. J. A. Wise.
Pitt Dr. C. O'H. Laughing-house.
Polk Dr. Earle Grady.
Randolph Dr. S. Henley.
Richmond Dr. Wm. P. Webb.
Robeson Dr. H. T. Pope.
Rockingham Dr. Sam Ellington.
Rowan Dr. W. L. Ci'ump.
Rutherford Dr. T. B. Twitty.
Sampson Dr. R. E. Lee.
Scotland Dr. A. W. Hamer.
Stanly Dr. Y. A. Whitley.
Stokes Dr. W. Y. McCanlesa.
Surry Dr. John R. Woltz.
Swain Dr. J. A. Cooper.
Transylvania Dr. C. W. Hunt.
Tyrrell
Union Dr. J. E. Ashcraft.
Yance Dr. Goode Cheatham.
Wake Dr. J. J. L. McCullers.
Warren Dr. A. S. Pendleton.
Washington Dr. W. H. AVard.
Watauga Dr. T. C. Blackburn.
Wayne Dr. Williams Spicer.
Wilkes Dr, J. M. Turner.
Wilson Dr. W. S. Anderson.
Yadkin Dr. S. L. Russell.
Yancey Dr. W. M. Austin.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 37
[You are asked to fill out and mail one of these forms to the Superintendent of Health of your
county on or before the third of each month, that he may use it in making his report to the Secretary
of the State Board.
Have any of the following diseases occurred in your practice during the month
just closed. If so, state number of cases.
Whooping-cough Typhoid Fever
Measles Typhus Fever
Diphtheria Yellow Fever
Scarlet Fever Cholera
Pernicious Malarial Fever Smallpox
Hemorrhagic Malarial Fever Cerebro-spinal Meningitis
What have been the prevailing diseases in your practice ?
Has any epidemic occui'red among domestic animals? If so, what?
What is the sanitary condition of your section, public and private?
General Remarks:.
M. D.
.190-— N. C.
NOTICE TO PHYSICIANS.
The biolog-ical laboratory of the Department of Agriculture will re-open
August 5. Application for bacteriological examination of drinking water
suspected, with good reason, of causing typhoid fever or epidemic dysen-tery,
may be made by any physician directly to the Secretary of the State
Board of Health, who must approve application.
The articles in this number bearing on typhoid fever are commended
to your attention.
^TTX^T^'^lTXl^T
OF THE
North Carolina Board of Health.
Published Monthly at the Office of the Secretary of the Board, Raleigh, N. C.
Geo. G.Thomas, M.D.,Pres., Wilmington. W. P. Ivey, M. D Lenoir.
S. Westray Battle, M. D...Asheville. Francis Duffy, M. D Xew Bern.
Henry W. Lewis, M. D Jackson. ! W. H. Whitehead, M. D Rocky Mt.
J. L. Nicholson, M. D Richlands. J. L. Ludlow, C. E Winston.
Richard H. Lewis, M. D., Secretary and Treasurer, Raleigh.
Vol. XVI. JULY, 1901. No. 4.
The Bacteriology of Typhoid Fever.
BY GERALD McCARTHY, M. Sc, BIOLOGIST
N. C. DEPARTMENT AGRICULTURE.
Typhoid fever is a specific or germ
disease due to a distinct and definite
microbe, Bacillus typhosus, which has its
biotic center in or about the intestines,
but acting secondarily upon other organs
of the body. During the progress of the
disease and for some time after convales-cence
this microbe—more commonly
known to physicians as the Klebs-Eberth
bacillus—is invariably found in the in-testines
and discharges therefrom. It is
also during convalescence generally found
in the bladder, urinary passages and
urine. In the urinary passages it is the
chief or sole cause of the cystitis and
abscesses which often follow typhoid.
There also exists in the intestines of
healthy persons and in most vertebrate
animals a microbe specifically called
Bacillus coli communis or colon bacillus.
By no microscopic examination nor by
any morphological test can we distin-guish
these two microbes from each
other. It is only by biological tests
—
the
growth of the two microbes on various
artificial culture media—that we are
able to distinguish one from the other.
The differences at best seem to be of de-
40 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
gree rather than kind. This fact has
led rqany bacteriologists to claim the
specific identity of the typhoid and the
colon microbes. These men hold that
under circumstances unknown to us the
common, nonpathogenic colon bacillus
may be transmuted into the deadly ty-phoid
bacillus. Most systematic or bo-tanical
bacteriologists claim provisionally
that the typhoid and colon microbes,
along with those producing hog cholera,
swine plague and yellow fever, are all
varieties of one species, of which the
original type is either lost or not yet
discovered.
But for practical purposes we must as-sume
that the colon and typhoid microbes
are distinct species. The colon bacillus
is common to men and most animals.
The typhoid bacillus is never found in
the animal body unless it has been pur-posely
introduced there by human con-trivance.
Animals cannot contract ty-phoid
fever!
Typhoid is endemic in North America
and is the filth disease par excellence of
this continent. How the bacillus is
spread and the disease engendered has
been copiously illustrated in a recent
report of the Medical Board appointed
to enquire into the cause of the typhoid
epidemics which scourged the American
camps during the late Spanish war.
In all of the camps the general tendency
of the regimental surgeons—who were
in almost every case recently taken from
civil practice—was to diagnose typhoid
as malaria or "typho-malaria." The
Medical Board found by blood examina-tion
and Widal tests that malaria was a
very rare disease in all of the camps ex-cept
those in Florida, and that "typho-malaria"
was in nearly every case plain
typhoid.
The report quoted shows by abundant
statistics that wherever 1,000 men are
brought together from diverse localities
at least three of them will bring in their
system the typhoid bacillus. Given these
three centers of infection and the
crowded, careless, filthy life inevitable
among raw recruits in camp, the spread
of the disease is inevitable and is sure
to figure on the hospital lists within
eight weeks after assembling the men.
It IS unnecessary therefore to. specu-late
upon the possible derivation of the
typhoid from the colon microbe. It
must also be borne in mind that since
animals do not harbor the typhoid germ
a dead animal on the water shed or
source of supply cannot cau^e typhoid
fever. For a similar reason dysentery,
gastric catarrh or other specific disease
has no causal relationship with typhoid!
The one sole and sufficient cause is the
typhoid microbe present in the bowel of
a non-immune person.
There is a belief among physicians
that there is some real connection be-tween
malaria and typhoid. The writer
has endeavored to show in a paper pub-lished
in this Bulletin—see Bulletin
North Carolina Board of Health, July,
1900—that malaria is a specific disease
requiring the agency of certain species
of mosquito as a carrier. The so-called
malaria supposed to be caused by ex-cavating
sewers, etc., during hot weather
cannot in the light of present knowledge
be the disease properly called malaria
and due to the presence in the blood
stream of the protozoan parasite Heeamceba
vivax. That parasite does not exist in
the soil! On the other hand the soil of
streets is apt to be polluted by the ty-phoid
microbe and the turning up of the
soil during the hot dusty season is liable
to cause infection. It is a great pity
that physicians do not more frequently
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 41
liave recourse to the Widal test and
blood examination in diagnosing malaria
and typhoid.
The incubation period of typhoid
microbe, or in other words the time
which must elaj'se between the intrusion
of the microbe into the human alimen-tary
tract and the appearance of recog-nizable
symptoms of the disease, is about
lOj days. But the microbe begins to
multiply within half hour after reaching
the bowel. The bowel discharges con-tain
the microbes in vast numbers within
24 hours after the original germ gained
access. Therefore a person may for
nine days continue to scatter virulent
typhoid germs in his bowel discharges
before the disease can be diagnosed.
This fact accounts for many of the seem-ingly
mysterious outbreaks of typhoid!
After convalesence the patient continues
to give off the germ, especially with the
urine, for a period of several weeks. In
case of cystitis or abscess following ty-phoid
the germs may continue to be
given off for a year or as long as the
seqi'.elx last I
Probably nine out of ten cases of ty-phoid
is contracted by drinking water
containing the typhoid germ In ordi-nary
potable water the life of the typhoid
germ is short. Usually 30 days is the
limit. The longest period definitely
established is 90 days. In polluted soil
however the microbe may continue to
exist and retain its virulence for more
than two years.
Bed sheets soiled by excrementa of a
typhoid patient can usually be disin-fected
by two hours exposure to strong
direct sunshine. Heavy blankets re-quire
a longer period. If such soiled
bedding, especially if it is moist, be
rolled up and cast into a dark or ob-scurely
lighted closet the microbes may
continue to live for as long as five or six
weeks. When earth containing this
microbe is dug up and dried into dust
the dust with living germs may be blown
to a distance of one-eighth mile. The
more common way of transferring in-fected
earth is, however, upon the feet of
persons and very likely on the feet of
sparrows and other birds which convey
the infection to the roofs of houses and
thence into cisterns or water barrels.
Probably a prime agency for spreading
typhoid is the common house fly. Ex-crementa
of typhoid infected persons is
commonly thrown into privies without
being previously disinfected. Xo at-tempt
is made to cover this material.
Flies gather upon it and sub.sequently
entering houses deposit the germs ad-hering
to their bodies upon food or drink
or vessels used for such purposes. In
this manner the germs eventually find
their way into the alimentary tract of
non-immune persons, who in due
time develop typhoid fever. The care,
lessness of the nurse and attendants in
handling food or food vessels with im-perfectly
sterilized hands is another im-portant
factor in spreading the disease.
When a physician diagnoses a case of
typhoid the first precaution should be to
have made up an abundant supply of an
antiseptic solution. The best antisep-tic
is carbolic acid. The best strength
to use in the sick-room is 3 per cent. To
make up such a solution take four
ounces of carbolic acid and dissolve in
one gallon of clean soft water. Use this
solution freely for washing the hands,
buttocks and other soiled parts. Rinse
bed-pans and chamber vessels with this
solution and cover all evacuations and
let stand for 10 minutes before casting
into sink or privy. Soak .soiled linen
and bedding in boiling water for 10
42 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
minutes and diy before casting into the
laundry basket. After the patient is
convalescent order the sick room to be
scrubbed with boiling hot water and
then use the above disinfectant. It is
not necessary to burn bedding or carpet-ing.
Expose these freely to the sun for
several days. One may with impunity
sleep in a bed infected by virulent ty-phoid
germs so long as these germs do
not find their way into the mouth.
There is no other gate-way for this
microbe
!
After the patient is convalescent he
should be carefully instructed to cover
his evacuations with dry earth or air-slaked
lime. This must be done so
thoroughly that flies cannot get at the
infectious material.
Every sanitarian and thoughtful phy-sician
should discourage the use of dug
wells. This type of well is now obsolete.
The digging of wells in incorporated
cities and towns should be prohibited as
a menace to public health. Driven or
drilled wells, not less than one hundred
feet deep, with metallic casing, is the
only trustworthy and hygienic source
of a supply of ground- water for drinking
purposes.
In cities and towns having a public
water supply the use of shallow or dug
wells should be abandoned at once and
in toto. It is a comparatively easy
matter to watch a public water supply,
but it is practically impossible to prop-erly
guard a multitude of private wells.
The writer is not tooting for water
companies, but it is only fair to state
that all such supplies so far tested in
the biological laboratory of the Xorth
Carolina Department of Agriculture
showed unexceptional water. The re-verse
is true of the majority of well
waters examined. Many of these well
waters were scarcely diluted sewage.
Especially was this the case with waters
from the eastern part of the State, where
the soil is light and the permanent
water level within a few feet of the sur-face.
A pure and trustworthy water
supply is the first essential for good
health. It is the last thing wpon which
people should economize.
Some Brief Extraets from an Al»straet
of Report on the Origiii and Spread of
Typlioid Fever ii» V. S. 3Iilitary Camps
Dnriug tUe Spaiiisli "War of 1898.
We have recently received from the
Surgeon-General of the Army a copy of
the publication named above, and a most
interesting and valuable document it is.
Emanating from men of such high
standing in the profession, particularly
in this special line of investigation, as
composed the personnel of the commis-sion,
viz.: Surgeons Walter Reed, U. S.
A., Victor C. Vaughn, U. S. V., and E.
0. Shakespeare, U. S. V., it could not be
otherwise than valuable. We regret that
our want of space must limit our quota-tions
from Chapter xiv, Gener.\l State-ments
AND Conclusions, given under
fifty-seven heads, to a very few of gen-eral
interest and importance to the civil
practitioner. We omit the tabulated
statements and give only the summary
of them. The following are the ex-tracts
:
{S} The miasmatic theory of the origin of
typhoid fever is not supported by our investi-gations.
There are still a few who believe that
typhoid fever is due to a poison or miasm
given off from the earth in gaseous form.
We would not mention this obsolete the-ory
were it not for the fact that while in-specting
the camps we found intelligent
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 43
medical officers who believe that some
intangible local condition inherent in the
place was an important factor in the pro-duction
of the epidemic. There is ap-parent
in man a tendency to believe in
the evil genius of locality. He is prone
to attribute many of his misfortunes to
indefinable conditions surrounding the
place in which he has suffered. As we
have stated, no fact in our investigations
has been brought out more prominently
than the demonstration that locality was
not responsible for the epidemic. The
Fifteenth Minnesota first developed ty-phoid
fever at the fair grounds at St.
Paul. There is certainly no evidence
that there is any evil climatic influence
connected with this place. It carried
the epidemic with it to Fort Snelling,
which has long had the reputation of
being one of the most healthful army
posts in the United States. From Fort
Snelling the Fifteenth Minnesota was
transferred to the open fields of Camp
Meade, where generations of Pennsyl-vania
farmers have passed the average
number of years allotted to man with-out
suspecting that their country was
an unhealthy one. However, typhoid
fever continued with the command from
Minnesota because the men carried the
germs of the disease in their bodies,
clothing, bedding and tentage. Certainly
any rational being would prefer any
of the above mentioned localities to Port
Tampa as a place of summer residence,
and yet there was not a regiment in the
Fourth Army Corps, encamped for so
long a time in Florida, that had as many
cases of typhoid fever as did the Fif-teenth
Minnesota.
{9) The pytlKxjenic theory of tlie origin of
typhoid fever is not supported by our investi-gations.
Murchison proposed this theory of the
origin of typhoid fever. This author
states the theory in the following words :
Typhoid fever may be generated inde-pendently
of a previous case bv fermen-tation
of fecal, and perhaps other forms
of organic matter.
Translated into the terms of modern
medicine, this theory is founded upon
the belief that the colon germ may un-dergo
a ripening process by means of
which its virulence is so increased and
altered that it may be converted into the
typhoid bacillus, or at least may become
the active agent in the causation of ty-phoid
fever. Many French, English and
American army medical officers believe
that typhoid fever may originate in this
way. Rodet and Roux, of the French
army, have stated their belief that out-side
of the body the colon bacillus ac-quires
"typhogenic" properties. Sur-geon-
Captain Davies, assistant professor
of hygiene in the English Army Medical
School, has expressed his belief in this
theory. Some of the medical officers in
the American army have also given it
their adherence. Surgeon Davies gives
the following statement of the reasons
for his belief in this theory :
It is well known that "camp diarrhea
"
is of the commonest occurrence among
troops shortly after taking the field in a
tropical or subtropical climate. Change
of habits, change of food, improper or
unsuitable food, bad water, heat, and ex-posure
to sun and chill—these are all
obvious factors in its causation ; there is
nothing in any way specific. Let us con-sider
the sequel as regards the individual
and as regards his surroundings. The
individual may in some cases remain in
fairly good health and vigor, in spite of
a continuance of the bowel trouble;
other individuals mav suffer more from
the exposure, fatigue and weakening
effects of the continued Mux. The sur-roundings
may possibly be and remain
sanitary, the camp clean, the water pure ; but in all probability the reverse will be
the case—at any rate, in some instances
44 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
—the water bad, the soil fouled, veiy
likely overcrowding of the camp, with
consequent difficulty, if not impossibil-ity,
of proper removal or disposal of fecal
matters. Under certain conditions of
heat and moisture favorable to the de-velopment
and multiplication of low
forms of vegetable and animal life which
is the more likely or reasonable to ex-pect,
that diarrhea in weakly and ex-hausted
individuals should remain diar-rhea
and nothing more, or that with an
increase of filth and decomposition, pol-luting
soil, air, and water, a development
of lilth-generated, pythogenic poison
should take place, capable of causing in
such weakly persons a fever, with diar-rhea,
a poison of the organism, produ-cing
pyrexia and inflammation of certain
glands in the alimentary tract—in fact, a
epecitic fever? Is this supposition of the
evolution, gradual or rapid according to
circumstances, of a disease poison, de
pendent on increasing conditions of
pollution of soil, air, or water, either
separately or all three together, unreas-onable
or illogical? Would it not, on
the contrary, be more unreasonable to
suppose that, under such conditions,
there should be no evolution at all?
These conditions of camp pollution un-doubtedly
exist and tend to increase in
many instances. Are they to have no
effect? Is diarrhea to continue as sim-ple
diarrhea, or is evolution to come into
action and produce a new disease? New,
indeed, only because the causes neces-sary
for its production are just now
brought into action—spontaneously only
in the sense that water is of spontaneous
origin, when from hydrogen and oxygen
the electric spark has produced water
where no water was before.
We believe that the results of our in-vestigations
controvert this theory con-clusively.
In the tirst place, we have
been able to show that the specific
poison of typhoid fever was introduced
into every one of our national encamp-ments,
and with the disease as wide-spread
as it is in this country, we
believe that we have good reasons for
the claim that one or more men already
specifically infected with typhoid fever
enlisted in nearly every command.
There is, therefore, no necessity of re-sorting
to the theory that the colon
bacillus may be converted into the
typhoid bacillus. Moreover, all the
known facts of experimental bacteri-ology
are at variance with this theory.
The supposition that simple diarrheas
may develop into typhoid fever Avill
be again referred to.
{10) Our investigations confirm the doc-trine
of the specific origin of typhoid fever.
As has already been stated, we have
been able to trace the introduction
of typhoid fever into every one of our
national encampments and into the
majority of the regiments. In case of
the few commands about which there is
some uncertainty as to the men bringing
the typhoid infection from their homes,
we may state that in all of these there
was ample opportunity for the introduc-tion
of the specific poison from other
commands.
{12) Typhoid fever is disseminated by the
transference of t]ie excretions of an infected
individual to the alimentary canals of
others.
It is more than probable that many
individuals may for a while carry and
eliminate the specific bacillus of typhoid
fever without developing the disease
themselves. Later we will make state-ments
concerning the probable propor-tion
of men who are immune to this
disease. In discussing the etiology of
typhoid fever we have seen that persons
who have recovered from this disease
may for a long time continue to carry
and excrete the specific poison. We
have also shown that the longevity of the
Eberth bacillus outside of the body
under certain conditions is much greater
than is generally supposed. The agents
by which the specific germ of typhoid
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 45
fever may be disseminated have been
enumerated and quite fully discussed in
the chapter on etiology.
(~^5) Flies undouhtedly served as carriers
of the infection.
Flies swarmed over infected fecal mat
ter in the pits and then visited and fed
upon the food prepared for the soldiers
at the mess tents. In some instances
where lime had recently been sprinkled
over the contents of the pit, flies with
their feet whitened with lime were seen
walking over the food.
It is possible for the fly to carry the
typhoid bacillus in two ways. In the
first place, fecal matter containing the
typhoid germ may adhere to the fly and
be mechanically transported. In the
second place, it is possible that the
typhoid bacillus may be carried in the
digestive organs of the fly and be depos-ited
with its excrement.
{29) It is more than likehj that men trans-ported
infected material on their persons or
in their clothing and thus disseminated the
disease.
We have condemned the method
which was followed in many of the
camps of detailing men from the ranks
to act as orderlies at the hospitals. In
some of the commands it was cu-stomary
to detail 100 or more men from the line
every morning. These men went to the
hospitals, handled bed pans used by
persons sick with typhoid fever, and at
night returned to their comrades. The
most of these men were wholly ignorant
of the nature of infection and the
methods of disinfection. In fact, at one
of the division hospitals we saw order-lies
of this kind go fiom the hospital and
partake of their midday meal without
even washing their hands. These men
handled not only the food which they
ate, but passed articles to their neigh-bors.
It seems to us that a more certain
method for the dissemination of an in-fectious
disease could hardly have been
invented.
We have stated that in some of the
camps the surface, especially where there
were strips of wood, was frequently
dotted with fecal deposits. At the time
of our inspection of the Third U. S.
Volunteer Cavalry at Chickamauga it was
quite impossible to walk through the
woods near the camp without soiling
one's feet with fecal matter. Much of
this was probably specifically infected,
and it is by no means improbable that
the infection was carried by the men
into their tents, where blankets and
tentage became infected.
[31) It is probable that the infection was
disseminated to some extent through the air
in the form of dust.
The shell roads through the encamp-ment
at Jacksonville were ground into
the finest dust by the heavy army
wagons. The scavenger carts carrying
the tubs filled with fecal matter passed
along these roads and their course could
often be traced by bits of feces falling
from the tubs. Other vehicles ground
up the fecal matter and dust together
and the winds disseminated these par-ticles
here and there. Men inhaled this
dust. It was deposited on food in the
mess tents by the roadside, and men ate
the dust. Pollution of the soil with the
urine of those suffering with typhoid
fever was of frequent occurrence. Cases
of this disease under the diagnosis of
malarial fever were repeatedly treated by
the regimental surgeon throughout the
entire sickness. Patients still convales-cing
were also returned to their respect-ive
companies. Under these conditions
46 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
there must have been abundant oppor-tunity
for contamination of the camp
site with the specific germ. We are
therefore inclined to the opinion that
infected dust was one of the factors in
the dissemination of typhoid fever.
(41) Malaria loas not a prevalent disease
among the troops that remained in the United
States.
We have shown in the body of this
report that blood examination for the
Plasmodium of malaria made by compe-tent
men at Camp Alger, Chickamauga,
Knoxville, Camp Meade and Jackson-ville
show that malaria was a very rare
disease among the troops that remained
in the United States. This disease was
undoubtedly more common in some of
the camps than the blood examinations
would indicate, because these were made
for the most part on hospital patients
and not upon those who merely reported
to the regimental surgeon, were given
quinine and returned to duty in a day or
two. The malaria that did exist in the
national encampments in this country
yielded readily to quinine, and the cases
that did not yield to this treatment were
not malarial. It is unfortunate for
scientific medicine that a competent
man, properly equipped for making
blood examinations, was not stationed at
each division hospital at the time of its
organization. Certainly we have a right
to expect that the Government will use
the best and most scientific methods in
its army medical service. Had this been
done scientific medicine would have
been enriched by contributions of the
greatest value. Is it too much to ask
that a division hospital be furnished
with facilities for scientific diagnosis
equivalent to those possessed by all first-class
hospitals?
{4^) The continued fever that prevailed
among the soldiers in this country in 1898
was tyj^hoid fever.
There is no evidence that any other
continued fever was found among the
troops that remained in the United
States. We have mentioned the claim
of one .surgeon that dengue prevailed in
his regiment at Chickamauga. AVe
think it quite impossible for dengue to
have prevailed in one regiment while
all other troops of two army corps
encamped at the .same place escaped
this disease. It was claimed by some
that the continued fever prevalent at
Chickamauga diff'ered from typhoid
fever, and that it was a disease peculiar
to the place, and it was designated as
"Chickamauga fever." That the con-tinued
fever prevalent in our camps in
1898 was typhoid fever is demonstrated
by the following facts :
(a) When the temperature curve was
not vitiated by the use of antipyretics it
was that of tyjsical typhoid fever.
(b) The fever was not broken or ar-rested
by the administration of quinine.
(c) The death rate was that of typhoid
fever.
(c?) Whenever a post-mortem exami-nation
was made, and the total of these
examinations was considerable, the char-acteristic
lesions of typhoid fever were
found.
{4-3) In addition to the recognized cases of
typhoid fever, there were many short and
abortive attacks of this disease tvhich ivere
generally diagnosed as some form of ma-larial
fever.
While entertaining the opinion that
many of the short febrile attacks were
due to errors in diet, as our own investi-gations
proceeded we strongly inclined
to the belief that a considerable propor-tion
of these fevers of short duration
were due to infection with the typhoid
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 47
bacillus, and hence were to be considered
as cases of mild or abortive typhoid
fever. In other parts of this report we
have called attention to the coincident
rise and fall of these supposed malarial
fevers with the occurrence of recognized
typhoid fever in certain companies and
regiments. Our studies have shown
that those soldiers who had recovered
from these supposed malarial fevers of
short duration afterwards possessed a
relatively marked immunity against
typhoid fever, as compared with those
who had not suffered with these milder
fevers. The following table will give the
result of our investigation bearing on
this point in forty-eight regiments of the
Second and Seventh Army Corps :
^
48 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
duce typhoid fever is not supported by our
investigations.
This belief, which was formerly held by
many, is founded upon false conclusions
arising from erroneous conceptions of
the etiology of the disease. Moreover,
the early symptoms of typhoid fever are
often confounded with those of simple
gastro-intestinal catarrh.
(51) The belief that simple gastro-intesti-nal
disturbances predisjjose to typjhoid fever
is not supported by our investigations.
As has been elsewhere stated, the
members of this board began their in-vestigations
with the belief, which seems
to be quite generally held, that acute
diseases of the gastro-intestinal tract
render the individual more susceptible
to subsequent infection with typhoid
fever. However, our studies have forced
us to come to the following conclusions
concerning the relations between ty-phoid
fever and preceding temporary
disorders, including those diagnosed as
diarrhea, enteritis, gastro-enteritis, gas-tro-
duodenitis, intestinal catarrh, gastro-intestinal
catarrh, gastric fever, and
simple indigestion
:
(a) The temporary gastro-intestinal
disturbances of May and June had little
if any effect upon subsequent infection
with typhoid fever.
(6) The temporary gastro-intestinal
disturbances of July and August, instead
of predisposing to typhoid fever, gave a
certain degree of immunity against sub-sequent
infection with this disease. Our
investigations may be summarized as
follows
:
Of 9,481 men who had previous diar-rheal
attacks, 648, or 6.8 per cent.,
contracted typhoid fever ; whereas of
46,348 soldiers who had no preceding
diarrhea, 7,097, or 15.3 per cent., de-veloped
typhoid fever.
{5£) In a considerable per cent, (a little
more than one-third) of the cases of typhoid
fever xvhich are recorded as having been
preceded by some intestinal disturbance, the
preceding illness teas so closely folloived by
typhoid fever that we must regard the former
as having occurred ivithin the period of
incubation of the latter.
For particulars on this point see the
chapter on etiology.
{5S) More than 90 percent, of the men
xvho developed typhoid fever had no preced-ing
intestinal disorder.
In 7,745 cases in which this point was
especially investigated 7,097 (91.63 per
cent.) were not preceded by any intesti-nal
disorder.
{.57} The average period of incubation in
typhoid fever is probably about ten and a
half days.
Our data are not sufficient to enable us
to make any positive deduction on this
point, but from a careful study of 780
cases of typhoid feverin which the period
of incubation was based upon the aver-age
interval between connectable typhoid
attacks in tents or between diarrheal
and typhoidal attacks in the same indi-vidual
this was found to be 10.4 days.
The shortest period of incubation would
appear to be slightly less than eight
davs.
Revie-»v of Diseases for Jane, 1901.
KIXETY-OXE COUNTIES REPORTING.
Ninety-four counties have Superinten-dents
of Health.
Except in the case of the more conta-gious
and dangerous diseases the Super-intendent
has, as a rule, to rely upon his
own information alone, since few phy-sicians
can be induced to report cases of
non-contagious diseases to him.
"Where the number of cases is not given
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 49
or the prevalence of a disease otherwise
indicated, its mere presence in the county
is to be understood as reported.
For the month of June the following
diseases have been reported from the
counties named:
Measles.—Alexander, a few cases;
Beaufort, 1; Brunswick, several; Bun-combe,
3; Burke, 2; Caldwell, 20; Car-teret;
Columbus, a few; Currituck, a great
many; Duplin, 2; Graham, several; Gran-ville,
4; Haywood, several; Henderson,
13; Hyde, in all parts; Johnston; Lin-coln,
6; Macon, a few; Montgomery;
Moore, many; Perquimans, 50; Ran-dolph,
many; Eichmond, 5; Rocking-ham;
Stokes, 20; Watauga, epidemic;
Yadkin, general—27 counties.
Whooping-cough.—Cabarrus, 26; Cald-well,
10; Caswell, 1; Catawba, 4; Chat-ham;
Cleveland, several; Cumberland, a
few; Currituck, several; Durham, several;
Granville, 6; Iredell, several; Johnston;
Montgomery, 5; Moore, many; New
Hanover, 6; Orange; Polk, 8; Randolph,
general; Rockingham, a great many;
Rutherford, a few; Scotland, 11; Vance,
in all parts; Wake, 5; Watauga, many;
Wayne, a few; Wilson, 3; Yancey,
several—27 counties.
Scarlatina.—Buncombe, 14; Cleve-land,
a few; Davidson, 2; Durham, 4;
Iredell, 1; New Hanover, 1; Rowan, 1—7
counties.
Diphtheria.—Cabarrus, 1; New Han-over,
2; Polk, 1.
Typhoid Fever.—Alamance, 5; Alex-ander,
in all parts; Anson, a few; Ashe
2; Beaufort, 2; Brunswick, 5; Buncombe
3; Burke, 8; Cabarrus, 8; Caldwell, 6
Chatham, a few, of severe type; Cleve
land, several; Columbus, 4; Craven, G
Duplin, 4; Durham, 6; Edgecombe, 3
Franklin, 12 or 15; Gaston; Graham, 1
Granville, 4; Greene, 4; Halifax, 1
Harnett, a few; Hertford, 1; Iredell, 4;
Jones, 2; McDowell, 8; Macon, 6; Meck-lenburg,
4; Montgomery, 12; Nash, 7;
New Hanover, 14; Northampton, many;
Onslow, 3; Pender, 3; Perquimans, 2;
Polk, 9; Randolph, 10; Richmond, 10;
Robeson, a great many; Rockingham,
Rowan, 3; Sampson, a few; Scotland, 41;
20 or 30 of them at one cotton-mill;
Stanly; Stokes, 3; Surry, 2; Swain, 6;
Union, several; Vance, a few; Wake, 10;
Warren, 3; Wayne, several; Wilkes;
Yadkin, a few; Yancey, a few—57 coun-ties.
Malarial Fever.—Alamance, in all
parts; Anson; Beaufort; Brunswick;
Caswell; Chatham; Cherokee, 4 cases of
bilious fever; Craven, in all parts; Cur-rituck;
Gates; Graham, 1; Greene, in all
parts; Guilford; Halifax; Hertford; Hyde;
Iredell, 8; Jones; Montgomery; New Han-over,
in all parts; Onslow; Person; Samp-son;
Warren; W^ashington, in all parts;
Wayne; Wilkes; Wilson—27 counties.
Malarial Fever, Pernicious.—Beau-fort,
1; Hertford, 1; Hyde, 2; Washing-ton,
2.
Malarial Fever Hemorrhagic.—
Washington, 1; Wilson.
Diarrhceal Diseases, including Dys-entery.—
Alamance; Alleghany, in all
parts; Anson; Bertie; Brunswick; Burke,
in all parts; Caswell, in all parts; Ca-tawba;
Chatham; Cherokee, 30; Colum-bus,
in all parts; Currituck; Duplin;
Gates, in all parts; Graham; Granville;
Greene, in all parts; Halifax; Harnett;
Haywood; Jones; Lenoir; Lincoln; Mc-
Dowell; Mecklenberg; Mitchell; Moore;
Orange, in all parts; Pasquotank; Per-quimans;
Person; Randolph; Robeson;
Rockingham ; Rutheford ; Sampson ;
Stokes; Surry; Swain; Wake; Watauga;
W^ayne; Yancey—43 counties.
Influenza.—Union, a few cases.
50 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Mumps.—Caldwell, a few cases.
Small-pox.—Alamance, 9; Buncombe,
9; Burke, 1; Caswell, 1; Cleveland, 6;
Cumberland, 2; Durham, 10; Gaston, 8
(on July 4); Guilford, 6, one of these
was of the hemorrhagic form and fatal;
McDowell, 5; Mecklenburg, 8; Orange,
14; Person, 49; Rockingham, 2; Rowan,
1; Sampson, 1; Stanly, 3; Wake, 7.
Dr. J. W. Fulton, the Superintendent
of Health of Cherokee, writes: "I
visited the territory of the so-called
small-pox. I saw a number of the
patients and examined them carefully,
and if it is small-pox, it is not any small-pox
that I have seen heretofore. It is
on the line of this State and Georgia.
There have been, I suppose, one hundred
cases, with no deaths that can be attri-buted
to the disease that I know of. I
have advised steps to be taken to confine
the disease within the neighborhood."
Dr. J. G. Waldrop, Superintendent of
Health of Henderson county, says:
"We still have a few cases of what all
our physicians who see it call chicken-pox,
in severe form. I feel certain it
is that, but it is frightful in some cases.
I try to persuade them to keep others
away."
Varicella.—Wilson, a few.
Cholera ix Chickens.—Clay.
Cholera in Hogs.—Bertie, Columbus,
Hyde, Northampton, Pender, Richmond
and Robeson—7 counties.
No diseases reported from Bladen,
Chowan, Dare, Davie, Forsyth, Madison
and Pitt.
No reports from Jackson, Martin and
Transylvania.
Saininary of Mortuary Reports for
Jniie, 1901.
(twexty-one towns)
Aggregate popula- Wiite. Col'd. Total.
tion 63,870 39,760 103,630
Aggregate deaths... 102 111 213
Representing tem-porary
annual
death rate per
1,000 19.2 33.5 22 24.7
Causes of Death.
Typhoid Fever 549 Malarial fever 1 2 3
Whooping-cough ..0 6 6
Measles 1 1
Pneumonia 5 2 7
Consumption 9 13 22
Brain diseases 5 4 9
Heart diseases 2 7 9
Neurotic diseases... 3 3 6
Diarrhceal diseases 27 25 52
All other diseasses.. 40 41 81
Accident 3 4 7
Violence 10 1
102 111 213
Deaths under five
years 45 46 91
Still-born 17 8
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 51
mortuary Report for June, 1901.
Towns
AND RePOKTERS.
52 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
County Superintendents of nealtb.
Alamance Dr. H. R. Moore.
Alexander Dr. C. J. Carson.
Alleghany Dr. B. C. Waddell.
Anson Dr. J. H. Bennett.
Ashe Dr. J. W. Colvard.
Beaufort Dr. J no. G. Blount.
Bertie Dr. H. V. Dunstan.
Bladen Dr. Newton Robinson.
Brunswick Dr. J. A. McNeill.
Buncombe Dr. James Sawyer.
Burke Dr. J. L. Laxton.
Cabarrus Dr. R. S. Young.
Caldwell Dr. A. A. Kent.
Camden
Carteret Dr. F. M. Clark.
Caswell Dr. S. A. Malloy.
Catawba Dr. G6o. H. West.
Chatham Dr. H. T. Chapin
Cherokee Dr. J. F. Abernathy.
Chowan Dr. T. J. Hoskins.
Clay Dr. J. O. Nichols.
Cleveland Dr. B. H. Palmer.
Columbus Dr. I. Jackson.
Craven Dr.W. H. Street.
Cumberland Dr. Jno. D. McRae.
Currituck Dr. H. M. Shaw.
Dare Dr. W. B. Fearing.
Davidson Dr. Joel Hill.
Davie Dr. James McGuire.
Duplin Dr. O. F. Smith.
Durham Dr. N. M. Johnson.
Edgecombe Dr. L. L. Staton.
Forsyth Dr. John Bynum.
Franklin Dr. E. S. Foster.
Gaston Dr. J. H. Jenkins.
Gates Dr. W. 0. P. Lee.
Graham Dr. R. J. Orr.
Granville Dr. S. D. Booth.
Greene Dr. Joseph E. Grimsley.
Guilford Dr. Edmund Harrison.
Halifax Dr. I. E. Green.
Harnett Dr. O. L. Denning.
Haywood Dr. S. B. Medford.
Henderson Dr. J. G. Waldrop.
Hertford Dr. John W. Tayloe.
Hyde Dr. E. H. Jones.
Iredell Dr. Henry F. Long.
Jackson Dr. Wm. Self.
Johnston Dr. L. D. Wharton.
Jones Dr. S. E. Koonce.
Lenoir Dr. Ravmond Pollock.
Lincoln Dr. T. F. Costner.
McDowell Dr. B. A. Cheek.
Macon Dr. F. L. Siler.
Madison Dr. Jas. K. Hardwicke.
Martin Dr. W. H. Harrell.
Mecklenburg Dr. C. S. McLaughlin.
Mitchell Dr. V. R. Butt.
Montgomery Dr. M. P. Blair.
Moore Dr. Gilbert McLeod.
Nash Dr. J. P. Battle.
New Hanover Dr. W. D. McMillan.
Northampton Dr. H. W. Lewis.
Onslow Dr. E. L. Cox.
Orange Dr. D. C. Parris.
Pamlico
Pasquotank Dr. H. T. Aydlett.
Pender Dr. J. R. Thomson.
Perquimans Dr. C. 0. Winslow.
Person Dr. J. A. Wise.
Pitt Dr. C. O'H. Laughing.
house.
Polk Dr. Earle Grady.
Randolph Dr. S. Henley.
Richmond Dr. Wm P. Webb.
Robeson Dr. H. T. Pope.
Rockingham Dr. Sam Ellington.
Rowan Dr. W. L. Crump.
Rutherford Dr. T. B. Twitty.
Sampson Dr. R. E. Lee.
Scotland Dr. A. W. Hamer.
Stanly Dr. V. A. Whitley.
Stokes Dr. W. V. McCanless.
Surry Dr. John R. Woltz.
Swain Dr. J. A. Cooper.
Transylvania Dr. C. W. Hunt.
Tyrrell
Union Dr. J. E. Ashcraft.
Vance Dr. Goode Cheatham
Wake Dr. J. J. L. McCullere.
Warren Dr. A. S. Pendleton.
Washington Dr. W. H. AYard.
Watauga Dr. T C. Blackburn.
Wayne Dr. Williams Spicer.
Wilkes Dr J. M. Turner.
Wilson Dr. W. S. Anderson.
Yadkin Dr. S. L. Russell.
Yancey Dr. W. M. Austin.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 53
[You are asked to fill out and mail one of these forms to the Superintendent of Health of your
county on or before the third of each month, that he may use it in making his report to the Secretary
of the State Board.
Have any of the following diseases occurred in your practice during the month
jus

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library of
CI]e University of Hortl] Carolina
C O L L K C TI O N OF
NORTH C A R (3 L I N I A N A
K N D O W E D BY
JOHN SPRUNT HILL
of the class of 1889
This book must not
be token from the
Librory building.
Form No. 471
iBiiTHiX^EiTinsr
OF THE
North Carolina Board of Health.
Published Monthly at the Office of the Secretary of the Board, Raleigh, N. C.
Geo. G. Thomas, M. D., Pres., Wilmington.
S. "Westray Battle, M. D...Asheville.
Hexry W. Lewis, M. D Jackson.
Hexry H. Dodson, M. D Milton.
*C. J. O'Hagax, M. D Greenville.
J. L. Nicholson, M. D Richlands.
Albert Anderson, M. D "Wilson.
A. "W. Shaffer, Sa.\, Eng Raleigh.
Richard H. Lewis, M. D., Secretary and Treasurer, Raleigh.
Vol. XVI. APRIL, 1901. No. 1.
County Sanitary Committees.
The County Sanitary Committee being a
new body just created by the recently ad-journed
Legislature, we feel that it would not
be amiss to call attention to the very impor-tant
duty required of it in the immediate
futJire, namely, the election of a county super-intendent
of health.
According to section 7 of the same the
time of meeting shall be "for the election of
a county superintendent of health on the first
Monday in May, 1901, and every tw'o years
thereafter."
•In section 5 of the Act Relating to the
Board of Health, as amended, we find these
words: "They (the county sanitary commit-tee)
shall elect a registered physician, not a
member of the sanitary committee, to serve
two years, with the title of county superin-tendent
of health, and shall fix his compen-sation."
This is by far the most important
of the duties imposed upon the committee,
for upon the character and qualifications of -
* Deceased.
the superintendent of health depends the
success or failure of the administration of the
law bearing on the health interests of the
people of the county. The position of super-intendent
of health is no sinecure at any
time if he does his duty, requiring as it does
intelligence, conscientiousness and nerve or
"back-bone." AVhile this' is particularly
true during the prevalence of sniall-pox it is
likewise true at all times, for few counties
are rarely ever entirely free of a preventable
disease of some kind, notably typhoid fever,
scarlet fever or diphtheria. Although the
principal duties of the superintendent are
specifically set forth in sections 56 and 58
and others of the act, there is no specification
as to typhoid fever, but in section 5 a gen-eral
clause is inserted in these words: "The
duty of the county superintendent of health
shall be to carry out as far as possible such
work as may be directed by the county sani-tary
committee and by the State Board of
Health," to cover such sanitary wcfrk as may
not have been mentioned in detail. In this
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
connection we would respectfully suggest that
the sanitary committee make it one of the
specific duties of the superintendent, imme-diately
upon the occurrence of a case of
typhoid fever in his county, to apply to the
Secretary of the State Board of Health for
a permit for a bacteriological analysis of the
drinking water of the family in which the
case occurs or make it his business to see that
the attending physician makes the applica-tion
and has the analysis made 'promptly.
The reasons for this will he found in the
article following.
The responsibilities of the superintendent
being great, an inferior man cannot be ex-pected
to meet them fully. We feel sure
that the county authorities—the board of
county commissioners is practically the
county saniiary comiiiittee—cannot make a
better investment for their people than in
electing a good man and paying him a rea-sonably
fair salary. In regard to this ques-tion
of salary we beg leave to repeat a sug-gestion
previously made in a circular-letter
to the chairmen of the hoards of commis-sioners
to the eflfect that in fixing the salary
of the superintendent an understanding
should be had with him that if called upon
to treat cases of small-pox, which would
greatly cripple if not entirely destroy his
private practice, for the time being and for
some time thereafter,'lie would receive extra
compensation—a certain'definite amount per
day or per month. This would be only sim-ple
justice, and a clear understanding on this
point in the beginning would be more satis-factory
to both parties. The experience of
the past three years have shown that the
counties having efiicient superintendents cor-dially
suppoiled by their boards of commis-sioners
have come out of smallpox outbreaks
at much less expense than others in which
the conditions were different.
In conclusion, we wish to impress upon all
sanitary committees that they must elect a
county superintendent of health on the first
Monday in May, 1901. No discretion is left
them, but the law is mandatory. "
Bacteriological E^xamtuatious.
Our readers wii! doubtless remember read-ing
in these columns a few months ago a state-ment
of the enlightened and generous offer
made by our Department of Agricultural to
have made in its biological laboratory free
of charge bacteriological examinations of
all suspected drinking waters. It is with
much regret that we note the failure of our
physicians to take advantage of that offer to
any extent, there having been less than a
half dozen applications for such examina-tions.
It is certainly not because of a lack of
typhoid fever, for we find that it was present
last month in 11 counties. We are at a loss
to understand the want of appreciation
shown by the profession unless it is due to
force of habit. It is so well known that an in-fected
well or spring is at the bottom of most
cases typhoid fever, thai whenever a case
occurs a warning as to the water supply is
sounded. Intheinterf stof theother members
of the family in which the case occurs it is
clearly the duty of the attending physician
to ascertain as soon as pcs=;ible the cause of
the attack and, having found it, to protect
the family and others liable to come within
its reach against it. To do this in most in-stances
would require very little time or
trouble and the expenditure of ten cents in
postage, which t*^ family would no doubt
be only too gU "^p'y- We sincerely
hope that hereafter every physician in the
Stale wiio has a case of oid fever
will, as soon as the diagno. is made, or
even strongly suspected, write us for a per-mit,
which, together with instructions and a
sterilized bottle, will be gladly and promptly
sent. While on the subject of typhoid fever
we think it proper to call attention to an-
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
other source of infection, the fly, by copy-ing
the following short article from the last
number of the Bulletin of the Bacteriokgi-ca'
and Pathological Laboratory of the Dele-ware
State Board of Health :
A NEWLY RECOGNIZED SOURCE OP
INFECTION.
Top severe epidemic of typhoid fever in
Y>'ir troops in the late Americo-Spanish war
' as well as the numerous experiments on the
subject, bring to light the important fact
that typhoid fever is not only a "water-borne"
but to a great extent a "fly-bred"
disease. In a very able paper published in
the Popular Science Monthly, January, 1901,
("Flies and Typhoid Fever") Dr. Howard
states the following conclusions:
1. "In the army camps the latrines are
not properly cared for and where their con-tents
ai*e left exposed, Musca domestica
(the "house-fly") will, and does, breed in
these contents in large numbers, and is
attracted to them without necessary oviposi-tion.
2. " In towns where the box privy nuisance
is still in existence the house fly is attracted
to such places to a certain extent, though
not as abundantly as other flies, which,
however, are not found in houses.
3. " In the filthly regions of a city, where
sanitary supervision is lax, and where in
low alleys and corners and vacant lots
deposits are made by dirty people, the house-fly
is attracted to the stools, may breed in
them, and is thus a constant source of danger.
The writer has seen a '' nsit, made over
night in South Was' .n an alleyway
swarming with flies in the bright sunlight
of a June l 'ng, temperature 92° F., and
within thirty ..et of this substance were the
open doors and windows of the kitchens of
two houses occupied by poor people."
With regards to the various species of
flies the author has reached the following
conclusions:
1. "Of the seventy-seven species of flies
found under such conditions that their
bodies, especially their feet and their pro-boscides,
may become covered with virulent
typhoid germs, only eight are likely to carry
them to objects from which they can enter
the alimentary canal of man.
2. "Of these eight species, two, namely,
Lucilia coesas and Calliphoro erylhrocephala,
can very rarely carry such germs, though
they may carry the germs of putrifaction
and cause blood-poisoning, in lighting upon
abrasions of the skin or open wounds.
3. "Four of these specimens, namely,
Homaloymia camiculans Muscina siabulosus,
Phora femoraia and Sarcophaga triviolis,
possess some degree of importance, but
their comparative scarcity in houses renders
ihem by no means of prime importance.
4. "The common iittlefruit fly, Dorsophila
ampelophia, is a dangerous species.
5. "The house- fly is a constant source of
danger, and wherever the least carelessness
in the disposal or the disinfection of dejecta
exists, it becomes an imminent source of
danger."
The conclusion to be drawn from the above
is plain: always thoroughly disinfect the
bowel discharges (as the law requires) and
bury them.
A ^Vord ^vitli Siiperiuteiideiits of Healtb.
On the first Monday in May a superin-tendent
must be elected in every county. In
many if not most instances the present in-cumbents
will probably be re-elected, but in
many others new men will come into office.
We desire to call the attention of all out-going
siiperintendents to the importance of
their turning over immediately to their suc-cessors
such blanks, placards and literature
as they may have on hand and particularly
the little book on " Disinfection and Disin-fectants,"
recently sent out. Of all super-intendents,
those re-elected as well as the
new men, we make the earnest request that
they promptly notify us of their election.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
New Memljer! of tlie State Board of
Health.
His Excellency, Governor Aycock, has ap-pointed
the following gentlemen, their term
of oflBce to begin at the next meeting of the
Board, which will be held in Durham at the
time of the aieeting of the State Medical
Society, as required by law, probably during
the week in May beginning with the 20th,
although the local committee of arrange-ments
has not yet announced the exact date:
Drs. W. P. Ivey of Lenoir, and Richard H.
Lewis of Raleigh, for six years ; Drs. George
G.Thomas of Wilmington, and Francis Duffy
of New Bern, for four years; and Mr. J. L.
Ludlow, C. E., of Winsion-Salem, for two
years. Saving ourself the selections are ad-mirable,
the medical members being gener-ally
recognized among the strongest men in
the profession, and Mr. Ludlow being widely
known not cnly in this State but throughout
the South as a well-tquipped and successful
civil and sanitary engineer. But they follow
excellent men, from all of whom we part
officially with genuine regret.
R,evie-*v of Diseases for Marcli, 1901.
EIGHTY-XINE COUNTIES REPORTING.
Ninety-four counties have Superinten-dents
of Health.
Except in the case of the more conta-gious
and dangerous diseases the Super-intendent
has, as a rule, to rely upon his
own information alone, since few phy-sicians
can be induced to report cases of
non-contagious diseases to him.
Where the number of cases is not given
or the prevalence of a disease otherwise
indicated, its mere presence in the county
is to be understood as reported.
For the month of March the following
diseases have been reported from the
counties named:
Measles.—Alamance, a few cases; Beau-fort,
4; Biaden; Brunswick, several ; Bun-combe;
Burke, in all parts; Cabarrus, many;
Caldwell, 10; Carteret, several; Cherokee,
150 to 200; Clay, several; Cleveland, sev-eral;
Columbus; Dare, 18; Davidson; Dur-ham,
a few; Forsyth, in all parts; Gaston;
Gates, epidemic; Granville, 2; Guilforid, 2;
Haywood; Henderson, 13; Hyde, in all
parts; Jackson, 21; Johnston; Lincoln, in
all parts; McDowell; Macon, 4; Mecklen-burg,
50; Mitchell, many; Montgomery, 25;
New Hanover, 88; Onslow, 30; Pasquotank,
a few; Pender, in all parts; Perquimans, 60;
Polk, 4; Randolph, 25; Richmond, 20; Robe-son,
epidemic; Rutherford, in all parts;
Sampson, iu all parts; Scotland, 5; Stokes,
8; Swain, a few; Union, epidemic; Vance, a
few; Wake, 12; Washington, 6; Yancey,
many—51 counties.
Whooping-cough.—Alamance, a few
cases; Alexander; Ashe, 4; Beaufort, 2; Cald-well,
20; Craven, 6; Durham, a few; Gaston;
Granville, 15; Iredell, many; Jackson, in
all parts; Johnston; Lincoln, in all parts;
McDowell; Madison, 75; Martin, 10; Meck-lenburg,
a few; New Hanover, 1; Pasquo-tank,
a few; Polk, 1; Randolph, 10; Robe-son;
Rowan, 12; Surry, 6; Union, 2; Vance,
a few ; Wake, 14 ; Wayne, a few—27 coun-ties.
Scarlet Fever.—Buncombe, 2; Cald-well,
2; Davidson, 4; Franklin, 1; Jack-son,
a few; Mecklenburg, 1; Nash, 1; New
Hanover, 1; Wake, 2; Washington, 6—10
counties.
Diphtheria.—Ashe, 2; Brunswick, 2;
Halifax, 1; Macon, 1; Wake, 3—5 counties.
Typhoid Fever.—Beaufort, 4 ; Bertie, 1;
Brunswick, several; Buncombe, 2; Craven,
4; Harnett, a few; Jones, 1; Madison, 7;
Orange, 1; Wake, 1—11 counties.
Malarial Fever.—Caswell ; Lenoir
;
Perquimans.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Influenza.—Ashe; Beaufort; Bertie; Bla-den;
Cabarrus, general ; Catawba; Chatham,
general; Cherokee; Chowan, general ; Clay;
Cleveland; Currituck; Davidson; Franklin;
Gates ; Greene ; Harnett, general ; Haywood
;
Henderson; Iredell; Jackson, general; Jones;
Lenoir, general ; McDowell ; Macon ; Martin
general ; Montgomery ; Moore ; Nash ; New
Hanover; Northampton; Onslow; Orange;
Pender, general; Person; Pitt, general;
Randolph; Richmond; Robeson; Rocking-ham;
Sampson; Stokes; Surry, general; Swain;
Union ; Vance; Wake; Washington, general
;
Wayne; Yadkin, general—50 counties.
Pneumonia.—Ashe; Beaufort, in all parts
Bertie, in many parts ; Cabarrus, in all parts
Chatham; Chowan, Davie, Gates, in all parts;
Graham; Greene, in all parts; Harnett, in
many parts; Hertford; Hyde; Iredell; Jack-son,
in all parts; Jones; Lenoir, in nearly
all parts ; Martin; Northampton, in all parts
Perquimans; Pitt, in all parts; Richmond;
Robeson; Sampson, in nearly all parts;
Stanly; Swain; Union; ^Vake, in all parts;
Wayne; Yadkin, in nearly all parts—30
counties.
Mumps.—Caswell, 500; Franklin, in
nearly all parts; Guilford; Yadkin.
Varicella.—Jones, 2; McDowell; W^il-son,
in nearly all parts.
Simple Continued Fever.—Graham.
Small-pox.—Buncombe, 12 ; Cabarrus, 8
;
Chatham, 5; Cleveland, 4; Davidson, 31;
Durham, 38; Forsyth, 1; Greene, 17; Guil-ford,
7; Halifax, 1; Mecklenburg, 45; Nash,
3; Orange, 30; Pasquotank, 3; Person, 6;
Polk, 2; Robeson, 13; Wake, 5—18 counties.
Cholera in Hogs.—Ashe, Bertie, Cho-wan,
Cleveland, Hyde, Lenoir.
Distemper in Horses.—Chowan, Cleve-land,
Macon, Swain.
Hydrophobia IN Dogs.— Caswell.
No diseases reported from Edgecombe,
Warren, Watauga and Wilkes.
No reports received from Alleghany, An-son,
Cumberland, Duplin and Transylvania.
Snmmai'y of Mortuary Reports for
3Iarcli, 1901.
(twenty-five towns).
Only those towns frooa which certified
reports are received are included.
Aggregate popula- ^Vhite. Col'd. Total.
tion 77,539 49,151 126,890
Aggregate deaths... 106 108 214
Representing tem-porary
annual
death rate per
1,000 16.4 26.4 20.2
Causes of Death.
Typhoid fever 2 2
Scarlet fever 10 1
Malarial fever 2 2
Whooping-cough ..0 3 3
Measles 1 1
Pneumonia 25 19 44
Consumption 13 16 29
Brain diseases 5 6 11
Heart diseases 11 9 20
Neurotic diseases... 2 2 4
Diarrhceal diseases 12 3
All other diseases.. 41 47 88
Accident 3 2 5
Suicide Oil
106 108 214
Deaths under five
vears 20 19 39
Still-born 18 9
BULLETIN OP THE NORTH CAROLINA BOARD OP HEALTH.
Mortusjcj Report for March, 1901.
Towns
AND RePOUTEKS.
BULLETIN OF THE NORTH CAEOLIXA BOARD OF HEALTH.
County Superintendents of Health.
Alamance Dr. T. S. Faucette.
Alexander Dr. T. F. Stevenson.
Alleghanj' Dr. B. C. Waddell.
Anson Dr. E. S. Ashe.
Ashe Dr. Manley Blevins.
Beaufort Dr. P. A. Nicholson.
Bertie Dr. H. V. Dunstan.
Bladen Dr. Newton Robinson.
Brunswick Dr. J. A. McNeill.
Buncombe Dr. James Sawyer.
Burke Dr. J. L. Laxton.
Cabarrus Dr. D. G. Caldwell.
Caldwell Dr. A. A. Kent.
Camden
Carteret Dr. F. M. Clark.
Caswell Dr. S. A. Malloy.
Catawba Dr. Geo. H. West.
Chatham Dr. H. T. Chapin.
Cherokee Dr. J. F. Abernathy.
Chowan Dr. T. J. Hoskins.
Clav Dr. J. M. Sullivan.
Cleveland Dr. B. H. Palmer.
Columbus Dr. I. Jackson.
Craven Dr. R DuA^al Jones.
Cumberland Dr. J.YanceMcGougan.
Currituck Dr. H. M. Shaw.
Dare .Dr. W. B. Fearing.
Davidson Dr. Joel Hill.
Davie Dr. James IMcGuire.
Duplin Dr. James W. Blount.
Durham Dr. Z. T. Brooks.
Edgecombe Dr. L. L. Staton.
Forsyth Dr. John Bynum.
Franklin Dr. E. S. Foster.
Gaston Dr. J. H. Jenkins.
Gates Dr. W. 0. P. Lee.
Graham Dr. R. J. Orr.
Granville Dr. S. D. Booth.
Greene Dr. Joseph E. Grimsley.
Guilford Dr. Edmund liarrieon.
Halifax Dr. I. E. Green.
Harnett Dr. 0. L. Denning.
Haywood Dr. F. M. Davis.
"
Henderson Dr. J. G. Waldrop.
Hertford Dr. John W. Tayloe.
Hyde Dr. E. H. Jones.
Iredell Dr. Henry F. Long.
Jackson Dr. Wm. Self.
Johnston Dr. L. D. \yharton.
Jones Dr. S. E. Koonce.
Lenoir Dr. W. T. Parrott.
Lincoln Dr. T. F. Costner.
McDowell Dr. B. A. Cheek.
Macon Dr. F. L. Siler.
Madison Dr. Jas. K. Hardwicke.
Martin Dr. W. H. Harrell.
jMecklenburg Dr. F. M. Winchester.
Mitchell Dr. V. R. Butt.
Montgomery Dr. M. P. Blair.
Moore Dr. Gilbert McLeod.
Nash Dr. J. P. Battle.
New Hanover Dr. W. D. McMillan.
Northampton Dr. H. W. Lewis.
Onslow Dr. E. L. Cox.
Orange Dr. C. D. Jones.
Pamlico
Pasquotank Dr. H. T. Aydlett.
Pender Di-. L. L. Ardrey.
Perquimans Dr. C. C. Winslow.
Person Dr. J. A. Wise.
Pitt Dr. C. O'H. Laughing-house.
Polk Dr. Earle Gradv.
Randolph Dr. T. T. Ferree.
Richmond Dr. J. M. Ledbetter.
Robeson Dr. H. T. Pope.
Rockingham Dr. Sam Ellington.
Rowan Dr. W. L. Crump.
Rutherford Dr. W. A. Thompson.
Sampson Dr. R. E. Lee.
Scotland Dr. A. W. Hamer.
Stanly Dr. V. A. Whitley.
Stokes Dr. W. V. McCanlesa.
Surry Dr. John R. Woltz.
Swain Dr. J. A. Cooper.
Transylvania Dr. C. W. Hunt.
Tyrrell
Union Dr. J. E. Ashcraft.
Vance Dr. Goode Cheatham.
Wake Dr. J. J. L. McCullers.
Warren Dr. A. S. Pendleton.
Washington Dr. W. H. Ward.
Watauga Dr. E. F. Bingham.
Wayne Dr. Williams Spicer.
Wilkes Dr J. M. Turner.
Wilson Dr. W. S. Anderson.
Yadkin Dr. S. L. Russell.
Yancey Dr. W. M. Austin.
BULLETIN OF THE NORTH CAHOLINA BOAKD OP HEALTH. 9
[You are asked to fill out and mail one of these forms to the Superintendent of Health of your
county on or before the third of each month, that he may use it in making his report to the Secretary
of the State Board. ]
•
Have any of the following diseases occurred in your practice during the montli
just closed. If so, state number of cases.
Whooping-cough Typhoid Fever _
Measles • Typhus Fever
Diphtheria Yellow Fever
Scarlet Fever Cholera
Pernicious Malarial Fever Smallpox
Hemorrhagic Malarial Fever Cerebro-spinal Meningitis-
What have been the prevailing diseases in your practice?
Has any epidemic occurred among domestic animals? If so, what?
What is the sanitary condition of your section, public and private?
General Remarks:
M. D.
.190--- N. C.
B"crx-jiL:H!i:z3^
OF THE
North Carolina Board of Health.
Published Monthly at the Office of the Secretary of the Board, Raleigh, N. C.
Geo. G. Thomas, M. D., Pres., Wilmington.
S. "Westray Battle, M. D...Asheville
Henry W. Lewis, M. D Jackson.
Henry H. Dodson, M. D Milton.
*C. J. O'Hagan, M. D Greenville.
J. L. Nicholson, M. D Richlands.
Albert Anderson, M. D Wilson.
A. W. Shaffer, San. Eng Raleigh.
Richard H. Lewis, M. D., Secretary and Treasurer, Raleigh.
Vol. XVI. MAY, 1901. No. 2.
Iixflt^euza as a Factor of Recent
Mortality.
In view of our own experience during the
past winter and spring in the unusual mor-tality
from pneumonia, very often as a
feature of influenza or la grippe, we feel
that no apology is required for devoting a
large part of our space to the following very
interesting and instructive discussion of the
above subject which we find in the Monthly
Bulletin for March of the Department of
Health of the City of Chicago:
influenza as a factor of recent
mortality.
Pneumonia has displaced the "Great
White Plague"—pulmonary consumption
—
as the principal cause of death in Chicago
during the last ten years. In the previous
half century consumption had levied the
heaviest toll on human life in this city, but
Deceased.
in the decade 1891-1900 there were nine
per cent, more deaths from pneumonia than
from consumption.
Between 1851 and 1890, inclusive, during
which period deatl)s and their causes were
recorded with increasing accuracy and full-ness,
there were 25,719deaths from consump-tion
and 16,577 from pneumonia—9,182, or
more than thirty-five per cent, excess of
consumption deaths. Between 1891 and 1900,
inclusive, there were 22,957 deaths from
consumption and 25,228 deaths from pneu-monia—
2,271, or nine per cent, excess of
pneumonia deaths.
In the decade 1881-1890 there were
147,514 deaths recorded from all causes
—
out of which number there were 9,915 from
pneumonia, or 672 deaths from this cause
out of every 10,000 deaths from ail causes.
In the last decade, 1891-1900, there were
247,240 deaths recorded from all causes, in-cluding
25,228 deaths from pneumonia—or
1,019 deaths from pneumonia out of every
10,000 deaths from all causes.
12 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
In the furmer decade the death rate of
pneumonia was 12.36 per 10,000 of popula-tion.
In the last decade this death rate was
18.03 per 10,000 of population.*
The forgeoing figures show an increase of
nearly forty-six (45.8) per cent, in pro-portion
to population and of more than fifty
(51.6) per cent, in the actual number of
pneumonia deaths in the last over the pre-vious
decade.
Death rates of pneumonia advance enor-mously
with advancing age—roughly, in
this country from 100 in every 10,000 of
the population living between fifteen and
forty-five years, to 260 of those between
forty-five and sixty-five, and to 730 of those
over sixty-five years of age—and some part
of this Chicago increase is unquestionably
doe to the increasing age of its population.
This increase, however, is generally uniform
from one decade to another. In 1850 only
two per cent, of the population was over 60
years of age; in 1860 there was 2.6 per
cent.; in 1870, 3.2 per cent.; in 1880, 3.6
per cent., and in 1890, 3.8 per cent. The
rates of increase of this factor of the popu
lation in the successive decennial years over
the proportion in 1850 were, therefore, 30
per cent, in 1860; 60 per cent, in 1870; 80
per cent, in 1880; and 90 per cent, in
1890.t
During the thirty years 1861-1890, in-clusive,
the death rates from pneumonia
bear some relation to this rate of increase.
In the decade 1861-1870 these deaths
formed 3.9 per cent, of the total deaths
from all causes; in the two succeeding
decades they were respectively 5 and 6.7
wherever population figures are used in
this article they are those of the United States
Census in every instance—beginning with that of
1850. "Estimated population," population by
State, School or Citj' census, by directory pub-lishers,
b3' the "Two Million Club," ei al., are dis-regarded
for pre.sent purposes.
fPopulation by ages has not yet been furnished
by the Census Office for 1900.
per cent, of the total deaths. In the 1861-
70 decade they were at the rate of 92 deaths
per 100,000 of population ; in 1871-80 at
the rate of 107 and in 1881-90 at the rate of
123 per 100,000.
But in the last decade, 1891-1900, these
proportions rose t» more than ten (10.2)
per cent, of the total deaths from all causes
(as against an average of 4.4 per cent, for
the previous forty years), and to 180 (as
against a previous average of 96 for the
same period) per 100,000 of population.
Compared with the immediately preceding
decade, 1881-1890, there was an increase in
the last decade of nearly forty-six (45.9)
per cent, of pneumonia deaths in propor-tion
to population, while the increase in
the decade 1871-1880 was less than seven-teen
(16.5) per cent., and in the next decade,
1881-1890, it was less than sixteen (15.6)
per cent.
On the basis of the proportion of pneu-monia
deaths to deaths from all causes the
increase in the last decade over the previous
one is 52.2 per cent, and over the average
annual increase of the previous thirty years
it is nearlj' sixty-eight (67.8) per cent.
Obviously, the increasing pneumonia mor-tality
of the last decade is not due solely nor
chiefly to the increasing age of the popu-lation.
During this same period, 1891-1900, the
death rate of consumption, which had
steadily declined from 30.48 per 10,000 of
population in 1851-60 to 15.88 in 1881-90,
rose to 16.41 in the last decade—an increase
of 3.3 per cent. ; the bronchitis rate increased
8.4 per cent.; while the death rate from
diseases of the heart and circulatory system
increased 22 per cent.—or from 63 to 77 per
10,000 of population—and from nephritis
nearly 85 per cent., or from 32 to 59 per
10,000 population. Only the death rate
from diseases of the nervous system, out of
these five principal causes of death, shows a
BULLETIN OF THE XORTH CAROLINA BOARD OF HEALTH. 13
reduction during the last decade—to-wit:
from 27 lo 22 per 10,000 of population, a
reduction of 18 5 per cent.
The rate of reduction in the general death
rate, which had obtained during the pre-vious
forty years, also sufiered a material
check during this period. In the decade
1851-60 the average annual death rate was
35.72 per thousand; from 1861 to 1870 it
was 23.35 per thousand—a reduction of 34.6
percent.; between 1871 and 1880 the rate
was 21.16—a reduction of 9.4 percent, from
that of the previous decade; and between
1881 and 1890 the rate fell to 18.40—a fur-ther
reduction of 13 per cent. The gross re-duction
during the forty years was a little
more than 48 per cent, and the average re-duction
of each decade was 19 per cent.
But between 1891 and 1900 there were
247,240 deaths in an average annual popu-lation
of 1,399,212—an annual rate of 17.69
per thousand and a reduction of only 3.8
per cent, from the rate of the preceding dec-ade
as against a minimum reduction of 9.4
per cent, an average reduction of 19 per
cent., in the three previous decades.
In October, 1899, the fourth great pan-demic
of influenza began—"as others had
done before, in some of the distant provinces
of Russia, and by the beginning of Novem-ber
it had reached Moscow. By the middle
of November Berlin was attacked. By the
middle of December it was in London and
by the end of the month it had invaded
New York and was widely distributed over
the entire continent." Thus Osier; but
even his graphic summary fails to convey
an adequate idea of the rapidity of its
march. First heard of in Central Asia in
October, within two months it had caused
death ia Chicago and within three months
"it had reached its height in our city, at
which time (the last week in .January, 1890)
my belief is that over 100,000 of our citizens
were sufierers irom that cause alone." *
From the single influenza death in Decem-ber,
1899, the number rose to 64 in January,
1890, fell to 37 in February, rapidly
dropped to 2, 7, 1 and 1 respectively in the
next four months, after which there was a
lull until January, 1891, when there were 4
more deaths, 6 in February, 1"55 in March,
120 in April, dropping 23, 4, 1, 3, 2, 0, 2
and 16 respectively in the remaining months,
with a total of 336 influenza deaths recorded
during the year.
This actual mortality, however, very in-adequately
represents the import of epidemic
influenza to the public health. Its baleful
efi'ects in the two years are more clearly
seen in the fjllowing figures:
1889 1890 1891
Totiil deaths from all causes— lO.ylG 21 856 27.754
Rate.s per 1,00U population— 18.11 19.86 23.92
Total deaths from pneumonia— 11.70 20.73 28.98
Rates per 10,000 population.- 12.5 18.8 25.0
Total deaths from eonsumption, 14.89 19.72 21.20
Rates per 10,000 population.. 15.9 17.9 18.3
Total deaths from bronchitis.. 8.10 11.89 14.95
Rates per 10,000 population.. 8.7 10.8 12.9
The total deaths from all causes in 1891,
the second influenza year, are the highest in
number ever recorded in the history of the
city up to date, and are nearly one-third
greater in proportion to population than in
1889. The consumption death rate in-creased
15 per cent., the bronchitis rate one-half
and the pneumonia rate exactly doubled
in two years. Deaths from nephritis and
from heart diseases also markedly increased,
but not to the same extent as in the later
years of the decade.
f
*.Sivayne Wickersham, M. D., Commissioner of
Health, in .Annual Kep )rt of the Department of
Health for the year of I9iiu.
fThe permanent increase of consumption mor-tality,
also, was not marked until 1S94, the fifth
year of the influenza period. During the previous
seven years, 18S7-1S93, inclusive, the consumption
mortality formed 8.5 per cent, of the total mor-tality,
and was at the rate of 154 per 100,000 of
population. From 18;t4 to I'.IOO, inclu.'ive, it formed
9.8 per cent, of the total—an increase of 15.5 per
cent, in proportionate mortality—and was at the
rate of ISii perlO,OOOof the population, an increase
of 9 per cent, population proportion in tlie second
seven year period.
14 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
The cause of the delay in the increase of eon-sumption
mortality due to influenza, as compared
with the increase of pneumonia, is obvious. The
former disease is chronic, the later acute. Lesions
of the mucous membrane of the nose, throat and
air passages in the prevailing catarrhal bronchitis
of intiuenza and of the air cells in pneumonia per-mitted
the iavasion of the tubercle bacillus de
novo, while the characteristic prostration of the
disease and consequent impaired vital resistance
favored the development and activity of latent
bacilli already in the system. Even a mild attack
of influenza has often been the starting point of a
fata! attack of tuberculosis.
There was a marked subsidence of the
disease during 1892, in which year 103
deaths were referred to influenza—none
during the last seven months—and it was
hoped that the epidemic had ended; but
there was a recrudescence in 1893, with 88
deaths in the latter year and 51 in the
year 1898.
In the winter of 1894 95 the Commis-sioner
called attention to these facts, and
suggested that, in view of the demonstration
by Canon and Pfeiffer in 1892 of the micro-bial
origin of the disease, its bacteriologic
diagnosis was a matter of first importance,
and especially so since influenza simulated
so many other diseases. Physicians were
invited to send specimens from the throats
of suspected influenza patients to the Labora-tory
for examination and the Department
bacteriologists were requested to make a
special study of the bacillus.
Owing to the subsidence of the disease in
1896 and 1897—when there were only 17
and 15 influenza deaths resppctively—no
opportunity was aflTorded for the proposed
study and interest in the subject died out.
In the latter part of 1897, however, the
disease reappeared and 21 deaths from in-fluenza
were recorded during the month of
January, 1898. In the Department Bulletin
for that month the following statement was
published:
Verified returns for the month of January,
1898, as compared with the corresponding month
of 1897, show that there were 193 fewer deaths dur-ing
the month, the respective totals being 2,026
and 1,833. The decrease is entirely among children
under five years of age, of whom 888 died in
January a year ago and only 605 in the correspond-ing
month this year. This is a decrease of nearly
one-third. On the other hand, the deaths among
the middle-aged and beyond are in excess—an
excess caused chiefly by chronic diseases, such as
consumption, heart disease, Bright's disease, etc.,
to which must-be added 21 deaths from influenza
or la grippe, as against a total of 15 for the entire
year 1897.
Although this much-dreaded malady has not
again spread with its usual rapidity nor yet
assumed epidemic preportions in Chicago, the
Department is not entirely reassured as to its
future. It is noted that In London, Rome and in
certain places in France, where the disease has
been sporadic for some time past, it is becoming
epidemic and in some cases is assuming a gravity
which is very alarming.
These considerations led the Commissioner to
make the following statement to the public toward
the close of the month :
".\ftera period of unprecedented good health
and low death rate Chicago is threatened with an
epidemic visitation of one of the diseases most
dreaded by sanitarians. Against influenza or
grippe the preventive measures of sanitation and
public hygiene are powerless. As a recent writer
says :
' We can see it afar oft and trace its progress,
but can do nothing to stop it ; and it smites the
sanitarily pure with a severity on the whole much
the same as it shows to the rest of the world.
The Department has been anxiously watching its
progress in the city for several weeks, looping that
there might be some mistalje in the diagnosis,
since it so closely resembles some other diseases.
But this hope was swept away by the reports of
eight deaths from the 'strange and terrible
disease' during the last three days of the week
just closed (Jan. 22d). These were reported by
physicians of such eminence and experience as
to leave no room for doubt. Three of the deaths
vrere from the uncomplicated form of the disease,
but the remaining five showed the characteristic
malignant activity of the poison in fatal compli-cations
of pneumonia, apoplexy and nephritis.
"The last epidemic of this disease in Chicago
was a chief factor in increasing the total deaths
from 21,856 in 1890 to 27,754 in the epidemic year,
1891—an increase of more than one-fifth—and
numbers of the survivors have never since re-
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 15
gained their' former condition of mental and
physical health. This added terror of the disease
makes it all the more important that nothing
should be neglected which may tend to its restric-tion,
and to this end the Commissioner points out
that influenza or the 'grip' is a germ disease, and
therefore contagious. Hence the obivious thing
to do is to follow the advice of the authorities:
Keep out of the way of contagion.
The quotations that follow are from the article
Influenza in AUbutt's System of Medicine, by J. F.
Goodhart, iM. D., M. C, F. R. C. P., Physician to
Guy's Hospital, London, Eng., etc.:
•' Where strict isolation has been possible, as in
certain institutions, the disease has seldom ap-peared;
most risk of catching the disease is run
in public buildings or ill-ventilated rooms of any
sort, a street car or railway carriage with elo.sed
windows not excepted. By 'keeping out of the
way of the contagion' is meant, among other
things, avoiding close contact with one suSering
from the disease; do not sleep in the same room,
still less in the same bed, with such a sufferer, and
do not use any article or utensil in common with
such.
" It is also certain that all kinds of excesses in
living, as well as exposure and fatigue, invite at-tacks
of the disease. ' All observers have testified
to its frequency and to its heavy mortality, in the
alcoholic particularly, and also in the overworked
and harrassed.' They are further agreed that
self-dosing with so-called influenza cures and
specifics is not only useless but positively danger-ous,
and that mildness of attack and speedy re-covery
are best insured by taking to bed at once
and following the advice of a competent physi-cian.
' It is the worst folly to struggle on with
work and to attempt to fight the disease—a plan
that, although some came through successfully
(in the past epidemic), was nevertheless the
cause of the loss of many lives.' This is of
especial importance to those beyond middle age
with crippled liearts, kidneys or otlier vital organs,
" In some respects influenza resembles con-sumption
in its mode of propagation; therefore,
the same precautions with regard to the secretions
from the nose, mouth and throat should be
observed. These secretions literally teem with
the influenza bacillus and they should be im-mediately
destroyed or thoroughly disinfected
under the advice of the attending physician.
The rooms, bedding, clothing, etc., of influenza
patients should also be thoroughly disinfected
and the Department will perform such disinfec-tion
whenever notified.
"Thus far the diagnosis of influenza in Chicago
rests entirely upon the clinical .symptoms. Only
a very few specimens of the throat secretions or the
expectorate of alleged influenza patients have
been sent to the Laboratory in response to the
invitation of the Commissioner, and microscopic
examination of these has thus far failed to reveal
the presence of the Canon-Pfeitfer bacillus, in any
instance. Yet Kamen reports failing to find the
influenza germ in only one case out of a hundred
examined. The Commissioner renews his re-quest
to physicians attending influenza patients
to send specimens of the throat secretions and
expectorate of their patients either to the Main
Laboratory or to any of the sub-laboratories,
where they will be put under the microscope at
once and the result of the examination telephoned
without delay."
It was not, however, until the early part
of the following December (1898) that the
influccza bacillus was first identified in the
Department Laboratory and then only in
examinations of suspected diphtheria—no
specimens from influenza cases having been
received. Once identified the organism was
found with increasing frequency, and in the
Department Bulletin for January, 1899, Dr.
Wynekoop, Assistant Bacteriologist in
charge of bacterial diagnosis, contributed
the results of his study of upwards of a
hundred examinations and demnnstrated
the feasibility—through certain improve-ments
in technique—of the bacteriologic
diagnosis of influenza with as much cer-tainty
and as promptly as diphtheria is
diagnosed. Since that time, December, 1898,
the search for the Canon- Pfeiffer bacillus
has been as much a part of the routine of
that branch of the Laboratory work as is
the indentification of the Klebs-Loetiler, the
Eberth, the Koch, or the diplocuccus of
Class.
The germ has now been found in uncom-plicated
influenza, in bronchitis, conjunc-tivitis,
consumption, diarrheal dise.ise, diph-theria,
empyema, endocarditis, mouingitis,
nephritis, otitis media, parotitis, pneumonia,
scarlet fever, tonsillitis and whooping-cough
;
16 BULLETIN OF THE NORTH CAROLINA BOARD OP HEALTH.
and also in cases simulating cerehro-spinal
fever, lumbago, rheumatic fever and typhoid
fever.
What this pestilent organism is capable of
doing, how protean its manifestations, and
how mischievously puzzling the strictly
clinical diagnosis—may be seen in the fol-lowing:
About February 10th ult. (1899) a boy of seven
suddenly became ill with a chill, of short duration,
followed by headache and a temperature of 103.4°
F. For a number of days prior to the chill there
had been a condition closely resembling typhoid
—general languor, loss of appetite, coated tongue,
constipation, slight headache, nose-bleed and a
slight cough. The second day following the chill
the temperature rose to 105.6° F. and the pulse to
160. There were delirium, stupor and slight
convulsions—symptoms suggestive of meningitis,
but which could not be interpreted as such in the
absense of any muscular rigidity. The tempera-ture
continued near 105° F. another twenty-four
hours, when a slight erythema appeared over
parts of the body.
A coosulation was called, but a positive diagnosis
was not made. .Scarlet fever with a delayed rash
was suggested, and a hot pack ordered with the
hope of bringing out the rash should this be the
nature of the disease. The results were nega-tive.
A microscopic examination was then made
of the contents of the throat, and the presence of
great numbers of influenza bacilli was revealed.
The child was now treated for influenza with
prompt and decided improvement, the tempera-ture
falling to 102-101° F. and the pulse to 120-116.
The cough continued, however, and became more
harsh and distressing. Xo involvement of the
lungs or pleura could be discovered at this time.
During the following two weeks the typhoid
symptoms continued. Temperature varietl from
100tol03° F.; cough less pronounced; intestines
greatly distended with gas : iliac tenderness and
stools of a typhoid character. The nervous
symptoms however, were not those of typhoid,
the child being supersensitive to the touch, and
exhibiting an abnormally active mental condition.
A consulting physician was again called in, who
made a tentative diagnosis of typhoid fever com-plicated
by influenza. Widall's test was made on
several occasions, but at no time was a satisfactory
reaction obtained. What seemed to be a partial
reaction about the eighteenth day could not be
obtained later. Bacteriologic examinations were
made of the stools, and, after several attempts,
the influenza organism was isolated, which would
lead to the conclusion that this organism alone
was responsible for the intestinal symptoms. On
the tongue there were several small ulcers and
similar patches were noticed on the mucous
membrane of the lips and cheeks.
During the second week the Eustachian tubes
became affected, and later the cavities of the
middle ear. The otitis media ran the usual
course. Pus examined at the time of the rupture
of the tympanum contained the influenza bacillus,
and cultures made from the discharge revealed
the organism present in a pure condition. In
cultures examined at a later period there were
found streptococci. The intestinal symptoms dis-appeared
during the third week and the stools be-came
normal, but the temperature, which for
several days had been in the neighborhood of
100° F., began to rise a little each day, and re-spiration
became more rapid. This condition was
found to be due to an involvement of the right
pleura. Fluid began to accumulate and soon the
entire chest cavity of the affected side was filled.
Aspiration demonstrated the presence of pus.
Microscopic examinations made of the aspirated
fluid revealed the influenza organism. Small
portions of the pus were transferred to blood
serum and cultures obtained in which the bacillus
in question was found in a pure state.*
Infiuenza has, apparently, become domes-ticated
with us, and its baleful effects on the
health are sufficiently shown in the fore-going
facts and figures. Its early recognition
is the necessary first step to any restriction
of its spread—lo s?y nothing of its scientific
medical treatment. Laboratory fncilities
for such recognition are not adequately
utilized. The profession, as a whole, mani-fests
a singular indifference to the oppor-tunities
offered.
Before the recent recrudescence the ba-cillus
was detected in the Department
Laboratory in October, 1900, but it was not
until deaths from the disease bad occurred
in the following December that any demand
was made for examinations. Meanwhile, no
^Further Study of the Influenza Bacillus.
Monthly Bulletin, Department of Health : Lhieago,
March, 1899.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 17
precautions against a contagion which
spreads with almost lightning-like rapidity
were enforced. They were not enforced be-cause
the disease and, contequently, the
necessity for precautions, were' not recog-nized.
The way to fight influenza is through the
culture tube and the micrc scope.
Miiuicipal Saiiltatiou lii tlie Uiilted
States.
We have recently received frona the
author, Charles V. Chapin, M. D., Superin-tendent
of Health, Providence, R. I., a very
handsome volume of the above title of near-ly
1,000 pages, 113 illustiations, beautifully
printed on fine paper. Accompanying the
book was a note from Dr. Chapin, in which
he says: "I shall feel greatly honored if you
consider it worthy of notice in your monthly
bulletin." We are glad to say that we con-sider
it eminently "worthy of notice," for
while we have not been able to read it care-fully,
we have examined it sufficiently to note
with approval the following announcement
by the publishers, Snow and Farnham,
Providence:
"This volume deals with the practical ap-plication
of the principles of sanitary
science. It is not concerned with the theory
of sanitation, but narrates what is being
done in the United States along the lines of
public health work, and will prove of great
value to all who are interested in this sub-ject.
It is also a work of reference for
students of social science and municipal af-fairs
In this book health officials will find
answers to the questions that they are con-tinually
asking as to what is being done in
other communities. The extracts from
statutes and ordinances which have been
included, and the blank forms illustrating
public health procedures shown in the ap-pendix,
render the work unique, and one
which no health officer can afford to be
without."
A better idea of the scope of the book
can perhaps be obtained from the headings
of the fourteen chapters, which are in
order as follows: Sanitary Organizations
—
Registration of Vital Statistics—Nuisances —Specific Nuisances—Plumbing—Water,
Ice, and Sewers—Food, other than Dairy
Prod ucts—Dai ry Prod ucts—Communicable
Diseases, and one chapter entitled Legisla-tion—
Administrative Work—Disinfection,
Laboratory Work, Vaccination, Antitoxin
concluded with a consideration of hospitals
for such diseases, ambulances, quarantine
both maritime and inland—Refuse Dis-posal—
Miscellaneous Sanitary Work, which
includes among other things, diseases of ani-mals,
school hygiene, control of barbers,
prevention of blindness, nursing-bottles,
kerosene, sick poor and finances.
The special value of this publication lies
in the fact that it tells in a clear manner
how sanitary work is actually done to-day
in our country. The best way in the world
to learn how to do anything is to find out
how others who are experts in the business
do it. For that reason we cordially com-mend
it to our health officers, and especially
to our cities and towns, that those which
are already doing good sanitary work may do
better and that those which are doing prac-tically
nothing may begin and begin right.
In our judgment they could not make a
better investment than in the purchase of
" Municipal Sanitation in the United States,"
Snow and Farnhan, Publishers, Providence,
R. I. So, postpaid.
18 BULLETIN OF THE NORTH CAROLINA BOARD OP HEALTH.
Review of Diseases for April, 1901.
EIGHTY-NINE COUNTIES REPORTING.
Ninety-four counties have Superinten-dents
of Health.
Except in the case of the more conta-gious
and dangerous diseases the Super-intendent
has, as a rule, to rely upon his
own information alone, since few phy-sicians
can be induced to report cases of
non-contagious diseases to him.
Where the number of cases is not given
or the prevalence of a disease otherwise
indicated, its mere presence in the county
is to be understood as reported.
For the month of April the following
diseases have been reported from the
counties named:
Measles—Ala^iance, several cases ; Beau-fort,
4; Brunswick, many; Buncombe, 2;
Burke, many; Cabarrus, many; Caldwell, 6;
Chatham, a few; Cleveknd, many; Colum-bus,
in all parts; Currituck, 3; Gaston,
many; Gates*, a few; Granville, 8; Guilford,
3; Henderson 13; Hyde, in all parts; Jack-son,
24; Johnston, many; Lincoln, 12;
Mecklenburg, 30 ; Moore, several ; New Han-over,
36; Onslow, 75; Pasquotank, a few;
Perquimans, 40; Polk, 3; Richmond, epi-demic;
Robeson, epidemic; Rockingham;
Scotland, 1; Stanly, 12; Stokes, 5; Union,
epidemic; Wake, 8; Warren, 5; Watauga;
Yadkin, several; Yancey, many—39 counties.
Whooping COUGH —Alamance, a few;
Alexander, many; Beaufort, 3; Burke,
many; Caldwell, 10; Chatham, a few.
Chowan, several; Currituck, a few; Gra-ham,
several; Granville, 11 ; Iredell, a few ;
Johnston, many ; Lincoln, 12; Mecklenburg,
50; Mitchell, several; New Hanover, 2;
Onslow, 20; Pasquotank, a few; Perqui-mans,
15; Polk, 1; Rockingham; Scotland,
3; Stan y, 10; Surry, 4; Swain, 10; Vance,
several ; Wake, 30 ; Watauga ; Wayne, a
few; Wilson; Yadkin, general; Yancey,
many—32 counties.
Scarlet Fever—Buncombe, 1 ; Craven,
1; Davidson, 7; Guilford, 1; Mecklenburg,
20; New Hanover, 2; Rockingham 1—
7
counties.
Diphtheria—Cabarrus, 1; Davie, 4;
Franklin, 1 ; Richmond, 2—4 counties.
Typhoid Fever—Clay, 1 ; Harnett, a
few; Jackson, 1; Johnston, 1; Madison, 4;
Onslow, 1 ; Orange, 1 ; Polk, 1 ; Robeson ;
Rockingham; Stanly, 4; Swain, 1; Union,
2; Vance, a few; Yancey, 1—15 counties.
Malarial Fever—Cabarrus ; Craven
;
Guilford; Iredell; Lenoir; New Hanover;
Onslow; Orange, a few; Perquimans, in all
parts; Rockingham; Wayne—11 counties.
Malarial Fever—
H
emorrhagi
c
—
Cabarrus, 1; Craven, 1; Onslow, 1.
Influenza—Alleghany; Ashe; Cabar-rus,
a few; Catawba; Chatham, a few;
Cleveland, a few; Currituck, a few; Duplin;
Gaston, a few; Graham; Greene, in all
pans; Jackson; McDowell; Madison, in all
parts; Mitchell; Person, a few; Richmond;
Robeson; Sampson; Stokes; Transylvania;
Union ; V/arren—2S counties.
Bowel Diseases—Harnett; New Han-over;
Scotland.
Hydrophobia—Alleghany, 1, a child,
died seven weeks after being bitten.
Meningitis—Jackson, 1.
Mumps—Alarciance; Cabarrus, a few;
Columbus, in all parts; Gaston, many ; Guil-ford;
Lincoln, in all parts ; Wayne—7 coun-ties.
Pneumonia—Alleghany; Currituck, 2;
Franklin, 3 or 4; Graham, several; Gran-ville,
in many parts; Greene, in all parts;
Lenoir; Madison, in all parts; Mitchell;
Perquimans, 8; Person, a few; Robeson;
Scotland; Swain; Union; Warren; Yad-kin—
17 counties.
Rheumatism—Mitchell.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH, 19
Varicella—Cherokee, 8 or 10 ; McDow-ell;
Wilson.
Small-pox—Buncombe, 23; Cabarrus, 5;
Caswell, 9; Chatham, 13; Cleveland, 2;
Davidson, 10; Durham, 27; Forsyth, 1,
death; Greene, 6; Guilford, 23, last case
now discharged ; Halifax, 2, none now
;
Johnston, 15; Mecklenburg, 20, one at
present; Nash, 1; Orange, 6; Person, 8;
Polk, 2; Robeson, 2; Rockingham, 1;
Stanly, 3; Wake, 28—21 counties.
Cholera in Chickens—Perquimans;
Rockingham.
Cholera in Hogs—Ashe; Bertie;
Chowan; Lenoir.
Distemper in Horses—Burke; Cleve-land
; Graham ; Swain.
Hydrophobia, in Dogs—Brunswick,
Pink-eye in Horses—Wilkes.
No diseases reported from Bladen, Car-teret,
Dare, Edgecombe, Haywood, Jones,
Northampton, Pitt, Randolph, Rowan, Ruth-erford
and Washington.
No reports received from Anson, Cum-berland,
Hertford, Montgomery and Pender.
Sitininary of Mortnary Reports for
April, 1901.
(twenty-four towns).
Only those towns from which certified
reports are received are included.
Aggregate popula- White. Col'd. Total.
tion 77,594 47,367 124,961
Aggregate deaths... 77 87 164
Representing tem-porary
annual
death rate per
1,000 11.9 22.0 14.2
Causes of Death.
Malarial fever 1 1 2
Whooping-cough ..0 1 1
Measles .' 10 1
Pneumonia 10 12 22
Consumption 10 14 24
Brain diseases 6 6 12
Heart diseases 7 5 12
Neurotic diseases... 3 3
Diarrhoeal diseases 3 8 11
All other diseases.. 36 34 70
Accident 2 3 5
Violence 1 1
77 87 164
Deaths under five
years 27 18 45
Still-born - 4 6 10
20 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
mortuary Report for April, 1901.
Towns
AND Reporters.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 21
County Superintendents of Health.
Alamance Dr. T. S. Faucette.
Alexander Dr. T. F. Stevenson.
Alleghany Dr. B. C. Waddell.
Anson Dr. E. S. Ashe.
Ashe Dr. Manley Blevins.
Beaufort Dr. P. A. Nicholson.
Bertie Dr. H. V. Dunstan.
Bladen Dr. Newton Robinson.
Brunswick Dr. J. A. McNeill.
Buncombe Dr. James Sawyer.
Burke Dr. J. L. Laxton.
Cabarrus Dr. D. G. Caldwell.
Caldwell Dr. A. A. Kent.
Camden
Carteret Dr. F. M. Clark.
Caswell Dr. S. A. Malloy.
Catawba Dr. Geo. H. West.
Chatham Dr. H. T. Chapin.
Cherokee Dr. J. F. Abernathy.
Chowan Dr. T. J. Hoskins.
Clav Dr. J. M. Sullivan.
Cleveland Dr. B. H. Palmer.
Columbus Di'. I. Jackson.
Craven Dr. R. DuVal Jones.
Cumberland Dr. J.Vance McGougan.
Currituck Dr. H. M. Shaw.
Dare Dr. W. B. Fearing.
Davidson Dr. Joel Hill.
Davie Dr. James McGuire.
Duplin Dr. James W. Blount.
Durham Dr. Z. T.Brooks.
Edgecombe Dr. L. L. Staton.
Forsvth Dr. John Bynum.
Franklin Dr. E. S. Foster.
Gaston Dr. J. H. Jenkins.
Gates Dr. W. 0. P. Lee.
Graham Dr. R. J. Orr.
Granville Dr. S. D. Booth.
Greene Dr. Joseph E. Grimsley.
Guilford Dr. Edmund Harrison.
Halifax Dr. I. E. Green.
Harnett Dr. O. L. Denning.
Haywood Dr. F. M. Davis.
Henderson Dr. J. G. Waldrop.
Hertford Dr. John W. Tayloe.
Hyde Dr. E. H. Jones.
Iredell Dr. Henry F. Long.
Jackson Dr. Wm. Self.
Johnston Dr. L. D. Wharton.
Jones Dr. S. E. Koonce.
Lenoir Dr. W. T. Parrott.
Lincoln Dr. T. F. Costner.
McDowell Dr. B. A. Cheek.
Macon Dr. F. L. Siler.
Madison Dr. Jas. K. Hardwicke.
Martin Dr. W. H. Harrell.
Mecklenburg Dr. F. M. Winchester.
Mitchell Dr. V. R. Butt.
Montgomery Dr. M. P. Blair.
Moore Dr. Gilbert McLeod.
Nash Dr. J. P. Battle.
New Hanover Dr. W. D. McMillan.
Northampton Dr. H. W. Lewis.
Onslow Dr. E. L. Cox.
Orange Dr. C. D. Jones.
Pamlico
Pasquotank Dr. H. T. Aydlett.
Pender Dr. L. L. Ardrey.
Perquimans Dr. C. C. Winslow.
Person Dr. J. A. Wise.
Pitt Dr. C. O'H. Laughing-house.
Polk Dr. Earle Grady.
Randolph Dr. T. T. Ferree.
Richmond Dr. J. M. Ledbetter.
Robeson Dr. H. T. Pope.
Rockingham Dr. Sam Ellington.
Rowan Dr. W. L. Crump.
Rutherford Dr. W. A. Thompson.
Sampson Dr. R. E. Lee.
Scotland Dr. A. W. Hamer.
Stanly Dr. V. A. Whitley.
Stokes Dr. W. V. McCanless.
Surry Dr. John R. Woltz.
Swain. Dr. J. A. Cooper.
Transylvania Dr. C. W. Hunt.
Tyrrell
Union Dr. J. E. Ashcraft.
Vance Dr. Goode Cheatham.
Wake Dr. J. J. L. McCullers.
Warren Dr. A. S. Pendleton.
Washington Dr. W. H. Ward.
Watauga Dr. E. F. Bingham.
Wayne Dr. Williams Spicer.
Wilkes Dr J. M. Turner.
Wilson Dr. W. S. Anderson.
Yadkin Dr. S. L. Russell.
Yancey Dr. W. M. Austin.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 23
[You are asked to fill out and mail one of these forms to the Superintendent of Health of your
county on or before the third of each month, that he may use it in making his report to the Secretary
of the State Board.
Have any of the following diseases occurred in your practice during the month
just closed. If so, state number of cases.
Whooping-cough Tj^phoid Fever
Measles Typhus Fever
Diphtheria Yellow Fever
Scarlet Fever Cholera
Pernicious Malarial Fever Smallpox
Hemorrhagic Malarial Fever Cerebro-spinal Meningitis
What have been the prevailing diseases in your practice ?
Has any epidemic occurred among domestic animals? If so, what?
What is the sanitary condition of your section, public and private?
General Remarks:
M. p.
.190-— N. C.
:B"criL-i^E3i:i2:T
OF THE
North Carolina Board of Health.
Published Monthly at the Office of the Secretary of the Board, Raleigh, N. C
Geo. G. Thomas, M. D., Prfs., Wilmington.
S. Westeay Battle, M. D...Asheville.
Hentjy W. Lewis, M. D Jackson.
J. L. Nicholson, M. D Richlands.
W. P. IvEY, M. D Lenoir.
Francis Duffy, M. D New Bern.
W. H. Whitehead, M. D Rocky Mt.
J. L. TiUDLOw, C. E Winston.
Richard H. Lewis, M. D., Secretary and Treasurer, Raleigh.
Vol. XVI. JUNE, 1901. No. 3.
Tlie Meeting of tbe Board.
The annual meeting of the Board oc-curred,
as required by law, at the same
time and place as that of the State Medical
Society, May 21-22, at Durham. All the
members were present. Doctors Thomas
and Lewis were re-elected President and
Secretary, respectively. The Secretary re-ported
oflBcially the favorable action of the
State Board of Agriculture on the request to
have bacteriological analyses of suspected
drinking water made in their biological
laboratory, and the following resolution
was adopted :
Whereas, the State Board of Agricul-ture
responded favorably to the request of
the State Board of Health made at its last
annual meeting to provide in its biological
laboratory for the free bacteriological ex-amination
of drinking waters suspected of
conveying disease, especially typhoid fever;
and
Whereas, the work of this kind already
done shows even thus early its great value
to the people, actual and prospective; now,
therefore, be it
Resolved, That the State Board of
Health desires to put on record its appre-ciation
of this additional evidence of the
progressive and enlightened spirit displayed
by the State Board of Agriculture in its
work and to express its belief that the ex-penditure
for this purpose will be returned
many fold to the people of the State in the
saving of many valuable lives and great
loss of time from long illnesses and in the
education of the people as to the importance
and value of sanitation.
In compliance with the act of the last
Legislature creating a State Board of Em-balmers,
to be "appointed by the State
Board of Health, three of whom shall be
members of the State Board of Health, the
remaining two shall be practical embalm-ers,"
etc., Messrs. J. W. Harry, of Char-
26 BULLETIN OP THE NORTH CAROLINA BOARD OF HEALTH,
lotte, and H. W. Simpson, of New Bern,
practical embalmers, were elected for five
and four years, and Drs. Battle, Duffy
and Lewis, R. H., for three, two and
one years, respectively. This Board is
to meet for organization on July second.
A committee of three, composed of Henry
W. Lewis, M. D., J. L. Ludlow, C. E.,
and the Secretary, was appointed to prepare
a new edition of the "Instructions for
Quarantine and Disinfection."
The Treasurer made his annual report
and Drs. Ivey and Duffy were appointed a
committee to audit the same. They re-ported
it correct.
The CoD-joint Session with the State
Medical Society assembled, as usual, at 12 m.,
Wednesday. The Secretary read his report
which is appended. Following this was
quite an animated discussion upon the true
character of a disease which had prevailed
extensively in Wilson county, and about
which there was a difference of opinion be-tween
the Superintendent of Health of the
county on the one side and the State Small-pox
Inspector and a member of the State
Board of Health |on the other—the first
claiming it to be chicken-pox and the last
two small-pox. Unfortunately neither of
the last two gentlemen were present but the
general sentiment was all against the chick-en-
pox theory. We hope it may have been
chicken-pox and that nothing will be heard
from it next winter, but we must say we feel
very anxious about it.
The term of office of the four members
elected by the Society having expired.
Doctors S. Westray Battle, of Asheville, and
Henry W. Lewis, of Jackson, were elected
for the term of six years, to succeed them-selves,
and Doctors J. L. Xicholson, of
Kichlands, and W. H. Whitehead, of Rocky
Mount, for the term of four years.
The following is the report of tljc Secre-tary
:
ANNUAL REPORT OF THE SECRETARY.
The past year has been marked by greater
progress in our efforts to protect the public
health than any equal period in the history
of the Board. Our work in trying to edu-cate
the public mind up to the importance
and value of sanitation in its various forms
is beginning to tell. The evidence of this
is seen in the provision made by the Depart-ment
of Agriculture for the free biological
analyses of suspected drinking waters, in
addition to the chemical analyses it has been
making for years; in the valuable amend-ments
to our health law made by the last
Legislature—and made not grudgingly but
in a liberal and enlightened spirit; in the
enactment of a law regulating the embalm-ing
of dead bodies; in the increase in the
number of public water supplies—eight, or
thirty-three per cent, actually, and many
more prospectively ; and in the greater in-terest
taken by the people generally in such
matters.
The full report of the work of the Board
in detail from our last meeting at Tarboro
to January 1, 1901, will be found in the
Eighth Biennial Report, a copy of which
will be gladly mailed to any one desiring it,
and to which those interested are referred.
WATER ANALYSES.
The value of a bacteriological examination
in locating the cause of typhoid fever in
contaminated or infected drinking water is
now thoroughly established. There are
probably from eight to ten thousand cases
of typhoid fever in the State every year.
In very many instances a number of cases
following one another at longer or shorter
intervals have their origin in a common
infected well or spring. If the drinking
water supply of the first case should be
jrromptly examined bactericlogically, and the
fact of its infection demonstrated, a number
of the latter cases could be prevented.
BULLETIN OF THE NORTH CAROLINA BOARD OP HEALTH. 27
Kealizing this and deslrinsj to bring it di-rectly
to the attention of the profession, to-gether
wich the fact that the examination
could be obtained free of charge, I mailed
to every physician in the State the following
letter, in addition to publishing essentially
the same thing in The Bulletin, which
they also received
:
Raleigh, N. C, January 20, 1901.
My dear Doctor.-^—^As you will have
noticed in The Bulletin for December,
mailed you the first of the month, the State
Agricultural Department has made provis-ion
for the bacteriological examination of
drinking waters suspected of carrying dis-ease.
Since the article in The Bulletin
was written the Honorable Commissioner of
Agriculture has ruled that all applications
for such analysis must be made to the Sec-retary
of the State Board of Health, and
approved by him before the work will be
done, for the purpose of guarding his labo-ratory
against too numerous applications
based on mere curiosity. As the county
superintendent of health is the recognized
health officer of every county, application
should first be made to him, giving the rea-sons
for suspecting the water, with request
that he approve and forward to me, and upon
receipt I will, if satisfied as to the necessity
for the analysis, forward permit direct to
you. In urgent cases, application may be
made direct to me.
Whenever a case of undoubted typhoid
fever occurs in a family, their drinking
water should be analyzed bacteriologically
as soon as possible. By promptly having
this done, many cases of that disease would
be prevented. So, if you have any cases of
typhoid fever in your practice, send for per-mit,
stating in your application the number
of cases and the conditions.
Very truly yours,
Richard H. Lewis,
Secretary.
My efforts in this direction have, I regret
to say, borne but little fruit, only thirteen
applications for analysis having been made
by physicians in nearly four months. The
indifference of the profession in this matter
I find it difficult to explain, for while it is the
duty of the physician to cure diseases, it is
none the less his dutj' to prevent it when he
can—as all worthy of their calling will, of
course, admit. If we do not avail ourselves
of the privilege offered us it will, I fear, be
withdrawn. Unless the value to the people
of the State of this work can be demonstrated
to the satisfaction of the Board of Agri-culture
it will surely be discontinued, and
when it is too late we will realize what we
have lost. I hope, therefore, every one who
hears or reads this will make it an invaria-ble
rule in every case of typhoid fever, im-mediately
upon making the diagnosis, to
write me for a permit and a sterilized bottle.
While, in the letter, in order to show proper
respect for the office of county superintend-ent
of health and perhaps protect the De-partment
of Agriculture from occasional
unnecessary work, I made it a condition of
the issuance of the permit that the applica-tion,
except in urgent cases, should first be
made to that official, who would approve and
transmit to me, I have since abandoned it as
being cumbersome and promotive of delay.
As a matter of fact all these cases are urgent
cases, and a direct application to me will
secure the permit and bottle at once.
LEGISLATION.
Realizing from our experience in the man-agement
of small-pox during the past three
years that our law of 1893 was defective in
a certain vagueness as to tlie duties and
powers of county authorities in matters per-taining
to the public health, I prepared and
secured the passage by the General Assem-bly
of the act amendatory thereto given
below. This was done, I am glad to say,
without difficulty, as was to have been ex-pected
of a body of men of such intelligence
and character as those composing the recent
Legislature. Although nearly all the mem-bers
supported the bill, 1 feel that special
acknowledgment should be made to Sena-tors
Justice and Henderson, o£ the Judiciary
28 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Committee, for legal advice, and to Dr.
Speight, of Edgecombe, in the Senate, and
Dr. Stevenson, of Iredell, in the House, for
valuable aid.
The following is the act
:
AN ACT TO AMEND AN ACT RELATING TO
THE BOARD OF HEALTH, CHAPTER 214,
LAWS OF 1893.
The General Assembly of North Carolina do
enact:
Section 1. That section 2 of chapter 214,
Laws of 1893, be amended by striking out
in line two the words "two years" and in-serting
in lieu thereof the following: "two
for four years and two for six years and
their successors for six years," and by strik-ing
out in line five the words "two years"
and inserting in lieu thereof the following:
"one for two years, two for four years and
two for six years and their successors for six
years."
Sec 2. That section 4 be amended by
striking out in lines three and four respect-ively
the word "two" and inserting in lieu
thereof the word "six."
Sec 3. That section 5, as amended by
chapter 201, Laws of 1897, be stricken out
and the following substituted therefor :
"Section 5. There shall be an auxiliary
board of health in each county in the State,
whose function shall be, upon the call of the
chairman of the board of county commis-sioners,
to advise the county authorities in
all matters pertaining to the public health.
These boards shall be composed of all regis-tered
physicians resident in the county.
From this board two physicians, shall be
selected, one by the chairman of the board
of county commissioners and one by the
mayor of the county town, who, together
with the board of county commissioners,
shall constitute the county sanitary com-mittee,
of which committee the chairman of
the board of county commissioners shall be
ex officio chairman. Their term of office
shall be conterminous with that of the com-missioners
with whom they serve, and when
on duty they shall receive the same com-pensation
as is received by the county
commissioners. The county sanitary com-mittee
shall have the immediate care and
responsibility of the health interests of
their county. They shall make such rules
and regulations, pay such fees and salaries
and impose such penalties as in their judg-ment
may be necessary to protect and ad-vance
the public health. And any person
violating such rules and regulations shall
be guilty of a misdemeanor and may be
fined not exceeding fifty dollars or impris-oned
not exceeding thirty days. They
shall elect a registered physician, not a
member of the sanitary committee, to serve
two years, with the title of county superin-tendent
of health, and shall fix his compen-sation.
The duty of the county superinten-dent
of health shall be to carry out as far as
possible such work as may be directed by
the county sanitary committee and by the
State Board of Health. He shall always
promptly advise the Secretary of the State
Board of Health of the unusual prevalence
of disease in his county, especially of ty-phoid
fever, scarlet fever, diphtheria, yel-low
fever, small-pox and cholera. He shall
make the medico-legal post-mortem exam-inations
for coroners' inquests, attend the
inmates of the home for the aged and in-firm
and the prisoners in the jail or convict
camp of his county, and make exalminations
of lunatics for commitment. He shall be
the sanitary inspector of the home and jail,
including convict camps, of his county,
making monthly reports to the county com-missioners
and to the Secretary of the State
Board of Health."
Sec. 4. That section 8 be stricken out
and the following substituted therefor
:
"The meeting of the State Board of Health
for the election of officers shall be on the
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 29
second day of the annual meeting of the Med-ical
Society of the State of North Carolina in
1901, and every six years thereafter; and of
the county sanitary committee for the elec-tion
of a county superintendent of health on
the first Monday in May, 1901, and every
two years thereafter."
Sec. 5. That section 14 be amended by
inserting after the word "commissioners" in
line five the words "or county sanitary com-mittee."
Sec. 6 That section 15 be amended by
inserting between the words "town" and
"near" at the end of line two the words "or
the sanitary committee of a county"; by
striking out after the word "town" in line
fourteen the words " or county board of
health " and inserting in lieu thereof the
words "board of health or county sanitary
committee;" and by striking out after the
word "town" in line twenty-one the words
"or county board of health" and inserting ,
in lieu thereof the words "board of health
or county sanitary committee."
Sec. 7. That section 23 be amended by
striking out all of said section from tlie be-ginning
of line ten and inserting in lieu
thereof the following: "the sanitary com-mittee
of any county may make such regu-lations
and provisions for the vaccination of
its inhabitants and impose such penalties as
they may deem necessary to protect the
public health ; and any person violating
such regulations shall be guilty of a misde-meanor
and may be fined not exceeding
fifty dollars or imprisoned not exceeding
thirty days."
Sec. 8. That section 25 be amended by
adding thereto the following: "And any
person violating such regulations shall be
guilty of a misdemeanor and may be fined
not exceeding fifty dollars or imprisoned
not exceeding thirty days."
Sec. 9. That section 7 having been re-pealed
the number of section 8 be changed to 7
and of all subsequent sections in accordance
therewith.
Sec. 10. That this act shall be in force
from and after its ratification.
It will be seen that, stated in a few words,
to quote from the editorial comments thereon
in The Bulletin for February, these
amendments "consist essentially: In in-creasing
the term of members of the State
Board of Health from two years, all expiring
at the same time, to six years, so arranged
as to expire at different times, thereby as-suring
a continuing board; in the creation
of a "county sanitary committee," com-posed
of the board of county commissioners
and two physicians and endowed with defi-nite
responsibilities and powers; and in re-storing
the term of oflice of county superin-tendent
of health from one to two years.
Our law has always been defective in not
providing proper machinery for its admin-istration
by counties. That defect is now
remedied as satisfactorily, we think, as the .
conditions obtaining in our State will per-mit.
It will also be noted that the medical
profession is recognized as far as practicable,
and this we hope will revive their interest
in sanitary matters. It is true that the con-trol
remains in the hands of the board of
county commissioners, as they will always
be in a majority, but in all matters pertain-ing
to the public health, including the elec"
tion of a county superintendent of health,
two physicians will have a voice."
It also appears that the State Medical
Society must at this meeting elect two mem-bers
to serve for six years, and two for four
years, with the f >llowing members appointed
by His Excellency, Governor Aycock, viz.:
Drs. W. P. Ivey and Richard H. Lewis for
six years, Drs. George G. Thomas and
Francis Dufiy for four years, and Mr. J. L.
Ludlow, C. E., for two years.
In order that there might be no miscar-riage
in the organization of thecountv sani-
30 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
tary committees, I addressed a letter on
March 2d to every board of county commis-sioners
calling their attention to the amended
laws, at the same time mailing them a copy,
and again on March 28th I wrote to the
chairman of every board and to the mayor
of every county town, reminding them of the
duty imposed upon them of each appointing a
physician to serve as a member of the county
sanitary committee. Although I specially
requested that I should be notified of the
appointments and enclosed a postal card for
reply, there are still a number of counties
and towns to be heard from, and it is there-fore
impossible to say how many county
sanitary committees have been properly or-ganized.
The first fruits of this creation of practi-cally
a county board of health was shown
in a request from the committee of Guilford
county to your Secretary to visit Greensboro
and advise with them as to the probable
cause of much malarial fever just north of
the city in recent yeais, and the best means
of removing it ; and in a similar request
from the committee of the county of Dur-ham
to go to Durham and advise with them
as to the best management of the small-pox
which had gained a foot-hold in the county.
I complied with both requests.
SMALL- POX.
The history of small-pox in the State
during the past year is practically a repeti-tion
of that for the preceding two years,
although the number of cases is nearly one
thousand less, being 1,945 against 2,806 for
the year 1899-1900, of whom 530 were white
and 1,415 colored—a somewhat larger pro-portion
of whites than heretofore. The
death-rate has also been lower, 2.83 per cent,
for the whites against 4.78 per cent., and
1.63 per cent, for the colored against 1.44
per cent; total 1.95 per cent, against 2.31
per cent. This decrease is probably due to
the vaccination of a considerable proportion
of the people through the influence of pre-vious
scares, for otherwise a reasonable ex-pectation
was that there would be more
cases instead of fewer. This explanation is
rendered more probable by the fact that this
last year the disease has prevailed chiefly in
the country districts where vaccination has
not been practised as it has been in the cities
and towns, centres of population and trade.
Some time since I received from a friend
a copy of a poster illustrated with pictures
of cases of small-pox, and containing the
announcement, " vaccine sold here," which
he had picked up in Tennessee, and which
was accompanied by a letter suggesting that
they might be made useful in this State. It
revived a suggestion I made to the Board
several years ago to placard the State with
the simple rules of health, and immediately
appealed to me, so I wrote the Mulford Com-pany
asking if they could furnish me with
similar posters signed by the Board, and at
what price. In response they kindly sent
me several thousand in the form desired
without charge. I have distributed them in
a number of counties where small-pox was
prevailing and they seem to have been of
service. The man who would "rather have
small-pox than be vaccinated" stops talking
after seeing the pictures. The small-pox
inspectors, whose reports are attached, have
continued to be of much service, Governor
Aycock having given his consent to their
employment, as required by the section of
the law making a spec'al appropriation for
use when rendered necessary bv pestilential
disease. In tabulated form the small-pox
statement is as follows:
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
SMALL-POX IN NORTH CAROLINA, MAY 1, 1900, TO MAY 1, 1901.
31
Counties.
32 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
The county of Wilson has been omitted
from the foregoing table for the reason that
the figures could not be obtained from the
County Superintendent of Health because,
in his opinion, there has been no small-pox.
In his reply to my letter asking for his re-port
on sm'all-pox for the year he writes:
"Our discussion to-day before our County
Society was the eruptive disease that has
prevailed in this county for the past three
months, and it was the unanimous opinion
that it is not small-pox. I suppose there
have been 500 cases in the town and county
and only one death, and that in an old man
who was sick with la grippe nine days before
he broke out."
On the other hand the small- pox inspector
for that section of the State, who was sent to
the county at the request of a member of
the State Board of Health living there says
the disease was small-pox and two of the
leading physicians of the county in a letter
to the inspector dated May 11, 1901, says :
"We believe there has been small-pox in the
county in the practice of other physicians,
and we know there are cases of small-pox
we have seen."
The above is a simple statement of the
facts in the possession of the Secretary and
the candid reader can draw his own conclu-sions,
relying in doing so on the good char-acter
and sincerity of all the parties to the
controversy.
In conclusion, it is safe to say that we
are justified in feeling encouraged, and with
the more active support from the profession
at large still greater progress is in reach.
Revle^v of Diseases for May, 1901.
NINETY-ONE COUNTIES REPORTING.
Ninety-four counties have Superinten-dents
of Health.
Except in the case of the more conta-gious
and dangerous diseases the Super-intendent
has, as a rule, to rely upon his
own information alone, since few phy-sicians
can be induced to report cases of
non-contagious diseases to him.
Where the number of cases is not given
or the prevalence of a disease otherwise
indicated, its mere presence in the county
is to be understood as reported.
For the month of May the following
diseases have been reported from the
counties named:
Measles.—Alamance, 68 cases; Anson;
Ashe, 10; Beaufort, 2; Bladen, a few; Bruns-wick,
a great many; Cabarrus, 2; Caldwell,
20; Carteret; Chatham, 1; Columbus, a few;
Cumberland, a few ; Currituck, a few ; David-son,
several; Graham, several; Granville,
3; Guilford, 3; Henderson, 22; Hyde, 4;
Jackson, 25; Lincoln, 10; Macon, 3; Mont-gomery,
4; Moore, several; New Hanover,
21; Onslow, 20; Pasquotank, 2; Pender, a
few; Perquimans, 40; Polk, 1 ; Randolph, a
great many; Richmond, 20; Robeson, epi-demic;
Rowan, 30; Stanly; Stokes, 3; Swain,
a few; Wake, 69; Watauga, 20; Yadkin,
general ; Yancey, many—41 counties.
Whooping-cough.—Alamance, 47; Alex-ander,
epidemic; Beaufort, 2; Cabarrus, 12;
Caldwell, 10; Chatham, many; Chowan,
many; Craven, 2; Cumberland, a few; Cur-rituck,
a few; Davidson, several; Durham,
20; Granville, 8; Henderson, general;
Johnston, many ; Lincoln, 12; Mecklenburg,
20; Montgomery, 3; Moore, several; New
Hanover, 5; Pasquotank, 2; Pender, a few;
Person, 8; Polk, 15; Randolph, general;
Rockingham; Rutherford, a few; Scotland,
10; Stanly; Vance, epidemic; Wake, 27;
Watauga, a few; Wayne, a few; Wilson, a
few; Yadkin, general; Yancy, many—36
counties.
Scarlet Fever.—Buncombe, 4; David-son,
6; Greene, 3; Iredell, 1; Mecklenburg,
5 or 6; Rockingham, 2; Rowan, 1—
7
counties.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 33
Diphtheria.—Cabarrus, 2; Cleveland, 1;
Davie, 1; Granville, 20; Macon 1; Rocking-ham,
1 ; Wake, 1—7 counties.
Typhoid Fever.—Cabarrus, 2; Caldwell
3; Chatham, 6; Chowan, 1; Clay, 2; Colum
bus, 2; Craven, 2; Durham, 2; Granville, 1
Harnett, a few ; Iredell, 1 ; Jones, 2 ; Me
Dowell, 4; Macon, 2; Madison, 1; Mont
gomery, 2; New Hanover, 2; Onslow, 4
Pasquotank, 4; Pender, 1; Perquimans
2; Person, 1; Polk, 2; Randolph, 4; Robe
son; Rockingham, a few; Rowan, 2; Ruth
erford, 1 or 2; Sampson, a few; Scotland, 4
Stanly, in all parts; Surry 2; Union, 10
Vance, several ; Wake, 2—35 counties.
Malarial Fever.—Brunswick ; Cas-well;
Chowan; Cumberland; Currituck;
Duplin; Greene; Guilford; Halifax; Hyde;
Onslow; Orange; Pasquotank; Perquimans;
Person ; Warren—16 counties.
Malaria Fever, Hemorrhagic.—Cho-wan,
1 ; Perquimans, 1.
Malarial Fever, Pernicious.—Hyde.
Diarrhceal Diseases, Including Dys-entery.—
Alexander, general; Alleghany;
Anson, general; Ashe; Bertie; Burke; Cald-well;
Catawba; Cleveland; Columbus;
Craven; Duplin; Franklin; Gaston; Gran-ville;
Greene, general; Halifax; Harnett;
Haywood ; Henderson ; Hertford ; Iredell,
general; Lenoir; Lincoln, general; Mc-
Dowell; Macon; Martin, general; Moore,
general ; New Hanover, general ; Northamp-ton,
general; Onslow, general; Pasquotank;
Pender, general ; Perquimans ; Person ; Polk
;
Randolph; Richmond; Robeson, general;
Rockingham; Scotland; Stanly, general:
Stokes ; Surry, general ; Swain ; Transyl-vania;
Union, general. Wake; Watauga,
general ; Wayne—50 counties.
Influenza.—Craven, mild, in all parts.
Pneumonia.—Anson; Clay; Haywood;
Warren.
Varicella.—Caswell.
Small-pox.—Buncombe, 17; Cabarrus, 7
;
Caswell, 12; Chatham, 4; Cleveland, 8;
Cumberland, 20; Durham, 10; Gaston, 6;
Greene, 2; Guilford, 4; Johnston, 19; Meck-lenburg,
15; Orange, 10; Person, 29; Polk,
2; Robeson, 2; Rockingham, 2 ; Rowan, 2;
Stanly, 2; Wake, 12; Wayne, several—20
counties.
Black-LEG in Calves.—Ashe.
Cholera in Chickens.—Scotland.
Cholera in Hogs.—Ashe; Bertie; Hyde;
Robeson.
Distemper in Horses.—Alexander;
Burke; Graham; Yancy.
No disease reported from Dare, Edge-combe,
Forsyth, Gates, Mitchell, Nash and
Washington.
No reports received from Cherokee, Pitt
and Wilkes.
Snmniarj' of Mortuary Reports for
May, 1901.
(twenty-four towns).
Only those towns from which certified
reports are received are included.
Aggregate popula- WJiite. Col'd. Total.
tion : 72,928 45,752 118,680
Aggregate deaths... 103 9fl 202
Representing tem-porary
annual
death rate per
1,000 16.9 26.0 20.4
Causes of Death.
Typhoid Fever.' 10 1
Malarial fever 1 -6 7
Whooping-cough ..3 1 4
Measles 10 1
Pneumonia 10 12 22
Consumption 7 5 12
Brain diseases 8 8
Heart diseases 8 9 17
Neurotic diseases... 14 5
Diarrhoeal diseases 17 12 29
All other diseases.. 44 47 91
Accident 12 3
Violence 112
103 99 202
Deaths under five
years 36 35 71
Still-born 12 8 2o
34 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Mortuary Report for may, 1901.
Towns
AND EePOBTEES.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 35
County Superintendents of Healtli.
Alamance Dr. H. R. Moore.
Alexander Dr. C. J. Carson.
Alleghany Dr. B. C. Waddell.
Anson Dr. J. H. Bennett.
Ashe Dr. J. W. Calvard.
Beaufort Dr. Jno. G. Blount.
Bertie Dr. H. Y. Dunstan.
Bladen Dr. Newton Robinson.
Brunswick Dr. J. A. McNeill.
Buncombe Dr. James Sawyer.
Burke Dr. J. L. Laxton.
Cabarrus Dr. R. S. Young.
Caldwell Dr. A. A. Kent.
Camden
Carteret Dr. F. M. Clark.
Caswell Dr. S. A. Malloy.
Catawba Dr. Geo. H. West.
Chatham Dr. H. T. Chapin
Cherokee Dr. J. F. Abernathy.
Chowan Dr. T. J. Hoskins.
Clav Dr. J. 0. Nichols.
Cleveland Dr. B. H. Palmer.
Columbus Dr. I. Jackson.
Craven Dr.W. H. Street.
Cumberland Dr. Jno. D. McRae.
Currituck Dr. H. M. Shaw.
Dare .Dr. W. B. Fearing.
Davidson Dr. Joel Hill.
Davie Dr. James McGuire.
Duplin Dr. O. F. Smith.
Durham Dr. N. M. Johnson.
Edgecombe Dr. L. L. Staton.
Forsyth Dr. John Bynum.
Franklin Dr. E. S. Foster.
Gaston Dr. J. H. Jenkins.
Gates Dr. W. O. P. Lee.
Graham j....Dr. R. J. Orr.
Granville Dr. S. D. Booth.
Greene Dr. Joseph E. Grimsley.
Guilford Dr. Edmund Harrison.
Halifax Dr. I. E. Green.
Harnett Dr. 0. L. Denning.
Haywood Dr. S. B. Metford.
Henderson Dr. J. G. Waldrop.
Hertford Dr. John W. Tayloe.
Hyde Dr. E. H. Jones.
Iredell Dr. Henry F. Long.
Jackson Dr. Wm. Self.
Johnston Dr. L. D. Wharjon.
Jones Dr. S. E. Koonce.
Lenoir Dr. Raymond Pollock.
Lincoln Dr. T. F. Costner.
McDowell Dr. B. A. Cheek.
Macon Dr. F. L. Siler.
Madison Dr. Jas. K. Hardwicke,
Martin Dr. W. H. Harrell.
Mecklenburg Dr. C. S. McLaughlin.
Mitchell., Dr. Y. R. Butt.
Montgomery Dr. M. P. Blair.
Moore Dr. Gilbert McLeod.
Nash Dr. J. P. Battle.
New Hanover Dr. W. D. McMillan.
Northampton Dr. H. W. Lewis.
Onslow Dr. E. L. Cox.
Orange Dr. D. C. Parris.
Pamlico
Pasquotank Dr. H. T. Aydlett.
Pender Dr. J. R. Thomson.
Perquimans Dr. C. C. Winslow.
Person Dr. J. A. Wise.
Pitt Dr. C. O'H. Laughing-house.
Polk Dr. Earle Grady.
Randolph Dr. S. Henley.
Richmond Dr. Wm. P. Webb.
Robeson Dr. H. T. Pope.
Rockingham Dr. Sam Ellington.
Rowan Dr. W. L. Ci'ump.
Rutherford Dr. T. B. Twitty.
Sampson Dr. R. E. Lee.
Scotland Dr. A. W. Hamer.
Stanly Dr. Y. A. Whitley.
Stokes Dr. W. Y. McCanlesa.
Surry Dr. John R. Woltz.
Swain Dr. J. A. Cooper.
Transylvania Dr. C. W. Hunt.
Tyrrell
Union Dr. J. E. Ashcraft.
Yance Dr. Goode Cheatham.
Wake Dr. J. J. L. McCullers.
Warren Dr. A. S. Pendleton.
Washington Dr. W. H. AVard.
Watauga Dr. T. C. Blackburn.
Wayne Dr. Williams Spicer.
Wilkes Dr, J. M. Turner.
Wilson Dr. W. S. Anderson.
Yadkin Dr. S. L. Russell.
Yancey Dr. W. M. Austin.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 37
[You are asked to fill out and mail one of these forms to the Superintendent of Health of your
county on or before the third of each month, that he may use it in making his report to the Secretary
of the State Board.
Have any of the following diseases occurred in your practice during the month
just closed. If so, state number of cases.
Whooping-cough Typhoid Fever
Measles Typhus Fever
Diphtheria Yellow Fever
Scarlet Fever Cholera
Pernicious Malarial Fever Smallpox
Hemorrhagic Malarial Fever Cerebro-spinal Meningitis
What have been the prevailing diseases in your practice ?
Has any epidemic occui'red among domestic animals? If so, what?
What is the sanitary condition of your section, public and private?
General Remarks:.
M. D.
.190-— N. C.
NOTICE TO PHYSICIANS.
The biolog-ical laboratory of the Department of Agriculture will re-open
August 5. Application for bacteriological examination of drinking water
suspected, with good reason, of causing typhoid fever or epidemic dysen-tery,
may be made by any physician directly to the Secretary of the State
Board of Health, who must approve application.
The articles in this number bearing on typhoid fever are commended
to your attention.
^TTX^T^'^lTXl^T
OF THE
North Carolina Board of Health.
Published Monthly at the Office of the Secretary of the Board, Raleigh, N. C.
Geo. G.Thomas, M.D.,Pres., Wilmington. W. P. Ivey, M. D Lenoir.
S. Westray Battle, M. D...Asheville. Francis Duffy, M. D Xew Bern.
Henry W. Lewis, M. D Jackson. ! W. H. Whitehead, M. D Rocky Mt.
J. L. Nicholson, M. D Richlands. J. L. Ludlow, C. E Winston.
Richard H. Lewis, M. D., Secretary and Treasurer, Raleigh.
Vol. XVI. JULY, 1901. No. 4.
The Bacteriology of Typhoid Fever.
BY GERALD McCARTHY, M. Sc, BIOLOGIST
N. C. DEPARTMENT AGRICULTURE.
Typhoid fever is a specific or germ
disease due to a distinct and definite
microbe, Bacillus typhosus, which has its
biotic center in or about the intestines,
but acting secondarily upon other organs
of the body. During the progress of the
disease and for some time after convales-cence
this microbe—more commonly
known to physicians as the Klebs-Eberth
bacillus—is invariably found in the in-testines
and discharges therefrom. It is
also during convalescence generally found
in the bladder, urinary passages and
urine. In the urinary passages it is the
chief or sole cause of the cystitis and
abscesses which often follow typhoid.
There also exists in the intestines of
healthy persons and in most vertebrate
animals a microbe specifically called
Bacillus coli communis or colon bacillus.
By no microscopic examination nor by
any morphological test can we distin-guish
these two microbes from each
other. It is only by biological tests
—
the
growth of the two microbes on various
artificial culture media—that we are
able to distinguish one from the other.
The differences at best seem to be of de-
40 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
gree rather than kind. This fact has
led rqany bacteriologists to claim the
specific identity of the typhoid and the
colon microbes. These men hold that
under circumstances unknown to us the
common, nonpathogenic colon bacillus
may be transmuted into the deadly ty-phoid
bacillus. Most systematic or bo-tanical
bacteriologists claim provisionally
that the typhoid and colon microbes,
along with those producing hog cholera,
swine plague and yellow fever, are all
varieties of one species, of which the
original type is either lost or not yet
discovered.
But for practical purposes we must as-sume
that the colon and typhoid microbes
are distinct species. The colon bacillus
is common to men and most animals.
The typhoid bacillus is never found in
the animal body unless it has been pur-posely
introduced there by human con-trivance.
Animals cannot contract ty-phoid
fever!
Typhoid is endemic in North America
and is the filth disease par excellence of
this continent. How the bacillus is
spread and the disease engendered has
been copiously illustrated in a recent
report of the Medical Board appointed
to enquire into the cause of the typhoid
epidemics which scourged the American
camps during the late Spanish war.
In all of the camps the general tendency
of the regimental surgeons—who were
in almost every case recently taken from
civil practice—was to diagnose typhoid
as malaria or "typho-malaria." The
Medical Board found by blood examina-tion
and Widal tests that malaria was a
very rare disease in all of the camps ex-cept
those in Florida, and that "typho-malaria"
was in nearly every case plain
typhoid.
The report quoted shows by abundant
statistics that wherever 1,000 men are
brought together from diverse localities
at least three of them will bring in their
system the typhoid bacillus. Given these
three centers of infection and the
crowded, careless, filthy life inevitable
among raw recruits in camp, the spread
of the disease is inevitable and is sure
to figure on the hospital lists within
eight weeks after assembling the men.
It IS unnecessary therefore to. specu-late
upon the possible derivation of the
typhoid from the colon microbe. It
must also be borne in mind that since
animals do not harbor the typhoid germ
a dead animal on the water shed or
source of supply cannot cau^e typhoid
fever. For a similar reason dysentery,
gastric catarrh or other specific disease
has no causal relationship with typhoid!
The one sole and sufficient cause is the
typhoid microbe present in the bowel of
a non-immune person.
There is a belief among physicians
that there is some real connection be-tween
malaria and typhoid. The writer
has endeavored to show in a paper pub-lished
in this Bulletin—see Bulletin
North Carolina Board of Health, July,
1900—that malaria is a specific disease
requiring the agency of certain species
of mosquito as a carrier. The so-called
malaria supposed to be caused by ex-cavating
sewers, etc., during hot weather
cannot in the light of present knowledge
be the disease properly called malaria
and due to the presence in the blood
stream of the protozoan parasite Heeamceba
vivax. That parasite does not exist in
the soil! On the other hand the soil of
streets is apt to be polluted by the ty-phoid
microbe and the turning up of the
soil during the hot dusty season is liable
to cause infection. It is a great pity
that physicians do not more frequently
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 41
liave recourse to the Widal test and
blood examination in diagnosing malaria
and typhoid.
The incubation period of typhoid
microbe, or in other words the time
which must elaj'se between the intrusion
of the microbe into the human alimen-tary
tract and the appearance of recog-nizable
symptoms of the disease, is about
lOj days. But the microbe begins to
multiply within half hour after reaching
the bowel. The bowel discharges con-tain
the microbes in vast numbers within
24 hours after the original germ gained
access. Therefore a person may for
nine days continue to scatter virulent
typhoid germs in his bowel discharges
before the disease can be diagnosed.
This fact accounts for many of the seem-ingly
mysterious outbreaks of typhoid!
After convalesence the patient continues
to give off the germ, especially with the
urine, for a period of several weeks. In
case of cystitis or abscess following ty-phoid
the germs may continue to be
given off for a year or as long as the
seqi'.elx last I
Probably nine out of ten cases of ty-phoid
is contracted by drinking water
containing the typhoid germ In ordi-nary
potable water the life of the typhoid
germ is short. Usually 30 days is the
limit. The longest period definitely
established is 90 days. In polluted soil
however the microbe may continue to
exist and retain its virulence for more
than two years.
Bed sheets soiled by excrementa of a
typhoid patient can usually be disin-fected
by two hours exposure to strong
direct sunshine. Heavy blankets re-quire
a longer period. If such soiled
bedding, especially if it is moist, be
rolled up and cast into a dark or ob-scurely
lighted closet the microbes may
continue to live for as long as five or six
weeks. When earth containing this
microbe is dug up and dried into dust
the dust with living germs may be blown
to a distance of one-eighth mile. The
more common way of transferring in-fected
earth is, however, upon the feet of
persons and very likely on the feet of
sparrows and other birds which convey
the infection to the roofs of houses and
thence into cisterns or water barrels.
Probably a prime agency for spreading
typhoid is the common house fly. Ex-crementa
of typhoid infected persons is
commonly thrown into privies without
being previously disinfected. Xo at-tempt
is made to cover this material.
Flies gather upon it and sub.sequently
entering houses deposit the germs ad-hering
to their bodies upon food or drink
or vessels used for such purposes. In
this manner the germs eventually find
their way into the alimentary tract of
non-immune persons, who in due
time develop typhoid fever. The care,
lessness of the nurse and attendants in
handling food or food vessels with im-perfectly
sterilized hands is another im-portant
factor in spreading the disease.
When a physician diagnoses a case of
typhoid the first precaution should be to
have made up an abundant supply of an
antiseptic solution. The best antisep-tic
is carbolic acid. The best strength
to use in the sick-room is 3 per cent. To
make up such a solution take four
ounces of carbolic acid and dissolve in
one gallon of clean soft water. Use this
solution freely for washing the hands,
buttocks and other soiled parts. Rinse
bed-pans and chamber vessels with this
solution and cover all evacuations and
let stand for 10 minutes before casting
into sink or privy. Soak .soiled linen
and bedding in boiling water for 10
42 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
minutes and diy before casting into the
laundry basket. After the patient is
convalescent order the sick room to be
scrubbed with boiling hot water and
then use the above disinfectant. It is
not necessary to burn bedding or carpet-ing.
Expose these freely to the sun for
several days. One may with impunity
sleep in a bed infected by virulent ty-phoid
germs so long as these germs do
not find their way into the mouth.
There is no other gate-way for this
microbe
!
After the patient is convalescent he
should be carefully instructed to cover
his evacuations with dry earth or air-slaked
lime. This must be done so
thoroughly that flies cannot get at the
infectious material.
Every sanitarian and thoughtful phy-sician
should discourage the use of dug
wells. This type of well is now obsolete.
The digging of wells in incorporated
cities and towns should be prohibited as
a menace to public health. Driven or
drilled wells, not less than one hundred
feet deep, with metallic casing, is the
only trustworthy and hygienic source
of a supply of ground- water for drinking
purposes.
In cities and towns having a public
water supply the use of shallow or dug
wells should be abandoned at once and
in toto. It is a comparatively easy
matter to watch a public water supply,
but it is practically impossible to prop-erly
guard a multitude of private wells.
The writer is not tooting for water
companies, but it is only fair to state
that all such supplies so far tested in
the biological laboratory of the Xorth
Carolina Department of Agriculture
showed unexceptional water. The re-verse
is true of the majority of well
waters examined. Many of these well
waters were scarcely diluted sewage.
Especially was this the case with waters
from the eastern part of the State, where
the soil is light and the permanent
water level within a few feet of the sur-face.
A pure and trustworthy water
supply is the first essential for good
health. It is the last thing wpon which
people should economize.
Some Brief Extraets from an Al»straet
of Report on the Origiii and Spread of
Typlioid Fever ii» V. S. 3Iilitary Camps
Dnriug tUe Spaiiisli "War of 1898.
We have recently received from the
Surgeon-General of the Army a copy of
the publication named above, and a most
interesting and valuable document it is.
Emanating from men of such high
standing in the profession, particularly
in this special line of investigation, as
composed the personnel of the commis-sion,
viz.: Surgeons Walter Reed, U. S.
A., Victor C. Vaughn, U. S. V., and E.
0. Shakespeare, U. S. V., it could not be
otherwise than valuable. We regret that
our want of space must limit our quota-tions
from Chapter xiv, Gener.\l State-ments
AND Conclusions, given under
fifty-seven heads, to a very few of gen-eral
interest and importance to the civil
practitioner. We omit the tabulated
statements and give only the summary
of them. The following are the ex-tracts
:
{S} The miasmatic theory of the origin of
typhoid fever is not supported by our investi-gations.
There are still a few who believe that
typhoid fever is due to a poison or miasm
given off from the earth in gaseous form.
We would not mention this obsolete the-ory
were it not for the fact that while in-specting
the camps we found intelligent
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 43
medical officers who believe that some
intangible local condition inherent in the
place was an important factor in the pro-duction
of the epidemic. There is ap-parent
in man a tendency to believe in
the evil genius of locality. He is prone
to attribute many of his misfortunes to
indefinable conditions surrounding the
place in which he has suffered. As we
have stated, no fact in our investigations
has been brought out more prominently
than the demonstration that locality was
not responsible for the epidemic. The
Fifteenth Minnesota first developed ty-phoid
fever at the fair grounds at St.
Paul. There is certainly no evidence
that there is any evil climatic influence
connected with this place. It carried
the epidemic with it to Fort Snelling,
which has long had the reputation of
being one of the most healthful army
posts in the United States. From Fort
Snelling the Fifteenth Minnesota was
transferred to the open fields of Camp
Meade, where generations of Pennsyl-vania
farmers have passed the average
number of years allotted to man with-out
suspecting that their country was
an unhealthy one. However, typhoid
fever continued with the command from
Minnesota because the men carried the
germs of the disease in their bodies,
clothing, bedding and tentage. Certainly
any rational being would prefer any
of the above mentioned localities to Port
Tampa as a place of summer residence,
and yet there was not a regiment in the
Fourth Army Corps, encamped for so
long a time in Florida, that had as many
cases of typhoid fever as did the Fif-teenth
Minnesota.
{9) The pytlKxjenic theory of tlie origin of
typhoid fever is not supported by our investi-gations.
Murchison proposed this theory of the
origin of typhoid fever. This author
states the theory in the following words :
Typhoid fever may be generated inde-pendently
of a previous case bv fermen-tation
of fecal, and perhaps other forms
of organic matter.
Translated into the terms of modern
medicine, this theory is founded upon
the belief that the colon germ may un-dergo
a ripening process by means of
which its virulence is so increased and
altered that it may be converted into the
typhoid bacillus, or at least may become
the active agent in the causation of ty-phoid
fever. Many French, English and
American army medical officers believe
that typhoid fever may originate in this
way. Rodet and Roux, of the French
army, have stated their belief that out-side
of the body the colon bacillus ac-quires
"typhogenic" properties. Sur-geon-
Captain Davies, assistant professor
of hygiene in the English Army Medical
School, has expressed his belief in this
theory. Some of the medical officers in
the American army have also given it
their adherence. Surgeon Davies gives
the following statement of the reasons
for his belief in this theory :
It is well known that "camp diarrhea
"
is of the commonest occurrence among
troops shortly after taking the field in a
tropical or subtropical climate. Change
of habits, change of food, improper or
unsuitable food, bad water, heat, and ex-posure
to sun and chill—these are all
obvious factors in its causation ; there is
nothing in any way specific. Let us con-sider
the sequel as regards the individual
and as regards his surroundings. The
individual may in some cases remain in
fairly good health and vigor, in spite of
a continuance of the bowel trouble;
other individuals mav suffer more from
the exposure, fatigue and weakening
effects of the continued Mux. The sur-roundings
may possibly be and remain
sanitary, the camp clean, the water pure ; but in all probability the reverse will be
the case—at any rate, in some instances
44 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
—the water bad, the soil fouled, veiy
likely overcrowding of the camp, with
consequent difficulty, if not impossibil-ity,
of proper removal or disposal of fecal
matters. Under certain conditions of
heat and moisture favorable to the de-velopment
and multiplication of low
forms of vegetable and animal life which
is the more likely or reasonable to ex-pect,
that diarrhea in weakly and ex-hausted
individuals should remain diar-rhea
and nothing more, or that with an
increase of filth and decomposition, pol-luting
soil, air, and water, a development
of lilth-generated, pythogenic poison
should take place, capable of causing in
such weakly persons a fever, with diar-rhea,
a poison of the organism, produ-cing
pyrexia and inflammation of certain
glands in the alimentary tract—in fact, a
epecitic fever? Is this supposition of the
evolution, gradual or rapid according to
circumstances, of a disease poison, de
pendent on increasing conditions of
pollution of soil, air, or water, either
separately or all three together, unreas-onable
or illogical? Would it not, on
the contrary, be more unreasonable to
suppose that, under such conditions,
there should be no evolution at all?
These conditions of camp pollution un-doubtedly
exist and tend to increase in
many instances. Are they to have no
effect? Is diarrhea to continue as sim-ple
diarrhea, or is evolution to come into
action and produce a new disease? New,
indeed, only because the causes neces-sary
for its production are just now
brought into action—spontaneously only
in the sense that water is of spontaneous
origin, when from hydrogen and oxygen
the electric spark has produced water
where no water was before.
We believe that the results of our in-vestigations
controvert this theory con-clusively.
In the tirst place, we have
been able to show that the specific
poison of typhoid fever was introduced
into every one of our national encamp-ments,
and with the disease as wide-spread
as it is in this country, we
believe that we have good reasons for
the claim that one or more men already
specifically infected with typhoid fever
enlisted in nearly every command.
There is, therefore, no necessity of re-sorting
to the theory that the colon
bacillus may be converted into the
typhoid bacillus. Moreover, all the
known facts of experimental bacteri-ology
are at variance with this theory.
The supposition that simple diarrheas
may develop into typhoid fever Avill
be again referred to.
{10) Our investigations confirm the doc-trine
of the specific origin of typhoid fever.
As has already been stated, we have
been able to trace the introduction
of typhoid fever into every one of our
national encampments and into the
majority of the regiments. In case of
the few commands about which there is
some uncertainty as to the men bringing
the typhoid infection from their homes,
we may state that in all of these there
was ample opportunity for the introduc-tion
of the specific poison from other
commands.
{12) Typhoid fever is disseminated by the
transference of t]ie excretions of an infected
individual to the alimentary canals of
others.
It is more than probable that many
individuals may for a while carry and
eliminate the specific bacillus of typhoid
fever without developing the disease
themselves. Later we will make state-ments
concerning the probable propor-tion
of men who are immune to this
disease. In discussing the etiology of
typhoid fever we have seen that persons
who have recovered from this disease
may for a long time continue to carry
and excrete the specific poison. We
have also shown that the longevity of the
Eberth bacillus outside of the body
under certain conditions is much greater
than is generally supposed. The agents
by which the specific germ of typhoid
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 45
fever may be disseminated have been
enumerated and quite fully discussed in
the chapter on etiology.
(~^5) Flies undouhtedly served as carriers
of the infection.
Flies swarmed over infected fecal mat
ter in the pits and then visited and fed
upon the food prepared for the soldiers
at the mess tents. In some instances
where lime had recently been sprinkled
over the contents of the pit, flies with
their feet whitened with lime were seen
walking over the food.
It is possible for the fly to carry the
typhoid bacillus in two ways. In the
first place, fecal matter containing the
typhoid germ may adhere to the fly and
be mechanically transported. In the
second place, it is possible that the
typhoid bacillus may be carried in the
digestive organs of the fly and be depos-ited
with its excrement.
{29) It is more than likehj that men trans-ported
infected material on their persons or
in their clothing and thus disseminated the
disease.
We have condemned the method
which was followed in many of the
camps of detailing men from the ranks
to act as orderlies at the hospitals. In
some of the commands it was cu-stomary
to detail 100 or more men from the line
every morning. These men went to the
hospitals, handled bed pans used by
persons sick with typhoid fever, and at
night returned to their comrades. The
most of these men were wholly ignorant
of the nature of infection and the
methods of disinfection. In fact, at one
of the division hospitals we saw order-lies
of this kind go fiom the hospital and
partake of their midday meal without
even washing their hands. These men
handled not only the food which they
ate, but passed articles to their neigh-bors.
It seems to us that a more certain
method for the dissemination of an in-fectious
disease could hardly have been
invented.
We have stated that in some of the
camps the surface, especially where there
were strips of wood, was frequently
dotted with fecal deposits. At the time
of our inspection of the Third U. S.
Volunteer Cavalry at Chickamauga it was
quite impossible to walk through the
woods near the camp without soiling
one's feet with fecal matter. Much of
this was probably specifically infected,
and it is by no means improbable that
the infection was carried by the men
into their tents, where blankets and
tentage became infected.
[31) It is probable that the infection was
disseminated to some extent through the air
in the form of dust.
The shell roads through the encamp-ment
at Jacksonville were ground into
the finest dust by the heavy army
wagons. The scavenger carts carrying
the tubs filled with fecal matter passed
along these roads and their course could
often be traced by bits of feces falling
from the tubs. Other vehicles ground
up the fecal matter and dust together
and the winds disseminated these par-ticles
here and there. Men inhaled this
dust. It was deposited on food in the
mess tents by the roadside, and men ate
the dust. Pollution of the soil with the
urine of those suffering with typhoid
fever was of frequent occurrence. Cases
of this disease under the diagnosis of
malarial fever were repeatedly treated by
the regimental surgeon throughout the
entire sickness. Patients still convales-cing
were also returned to their respect-ive
companies. Under these conditions
46 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
there must have been abundant oppor-tunity
for contamination of the camp
site with the specific germ. We are
therefore inclined to the opinion that
infected dust was one of the factors in
the dissemination of typhoid fever.
(41) Malaria loas not a prevalent disease
among the troops that remained in the United
States.
We have shown in the body of this
report that blood examination for the
Plasmodium of malaria made by compe-tent
men at Camp Alger, Chickamauga,
Knoxville, Camp Meade and Jackson-ville
show that malaria was a very rare
disease among the troops that remained
in the United States. This disease was
undoubtedly more common in some of
the camps than the blood examinations
would indicate, because these were made
for the most part on hospital patients
and not upon those who merely reported
to the regimental surgeon, were given
quinine and returned to duty in a day or
two. The malaria that did exist in the
national encampments in this country
yielded readily to quinine, and the cases
that did not yield to this treatment were
not malarial. It is unfortunate for
scientific medicine that a competent
man, properly equipped for making
blood examinations, was not stationed at
each division hospital at the time of its
organization. Certainly we have a right
to expect that the Government will use
the best and most scientific methods in
its army medical service. Had this been
done scientific medicine would have
been enriched by contributions of the
greatest value. Is it too much to ask
that a division hospital be furnished
with facilities for scientific diagnosis
equivalent to those possessed by all first-class
hospitals?
{4^) The continued fever that prevailed
among the soldiers in this country in 1898
was tyj^hoid fever.
There is no evidence that any other
continued fever was found among the
troops that remained in the United
States. We have mentioned the claim
of one .surgeon that dengue prevailed in
his regiment at Chickamauga. AVe
think it quite impossible for dengue to
have prevailed in one regiment while
all other troops of two army corps
encamped at the .same place escaped
this disease. It was claimed by some
that the continued fever prevalent at
Chickamauga diff'ered from typhoid
fever, and that it was a disease peculiar
to the place, and it was designated as
"Chickamauga fever." That the con-tinued
fever prevalent in our camps in
1898 was typhoid fever is demonstrated
by the following facts :
(a) When the temperature curve was
not vitiated by the use of antipyretics it
was that of tyjsical typhoid fever.
(b) The fever was not broken or ar-rested
by the administration of quinine.
(c) The death rate was that of typhoid
fever.
(c?) Whenever a post-mortem exami-nation
was made, and the total of these
examinations was considerable, the char-acteristic
lesions of typhoid fever were
found.
{4-3) In addition to the recognized cases of
typhoid fever, there were many short and
abortive attacks of this disease tvhich ivere
generally diagnosed as some form of ma-larial
fever.
While entertaining the opinion that
many of the short febrile attacks were
due to errors in diet, as our own investi-gations
proceeded we strongly inclined
to the belief that a considerable propor-tion
of these fevers of short duration
were due to infection with the typhoid
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 47
bacillus, and hence were to be considered
as cases of mild or abortive typhoid
fever. In other parts of this report we
have called attention to the coincident
rise and fall of these supposed malarial
fevers with the occurrence of recognized
typhoid fever in certain companies and
regiments. Our studies have shown
that those soldiers who had recovered
from these supposed malarial fevers of
short duration afterwards possessed a
relatively marked immunity against
typhoid fever, as compared with those
who had not suffered with these milder
fevers. The following table will give the
result of our investigation bearing on
this point in forty-eight regiments of the
Second and Seventh Army Corps :
^
48 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
duce typhoid fever is not supported by our
investigations.
This belief, which was formerly held by
many, is founded upon false conclusions
arising from erroneous conceptions of
the etiology of the disease. Moreover,
the early symptoms of typhoid fever are
often confounded with those of simple
gastro-intestinal catarrh.
(51) The belief that simple gastro-intesti-nal
disturbances predisjjose to typjhoid fever
is not supported by our investigations.
As has been elsewhere stated, the
members of this board began their in-vestigations
with the belief, which seems
to be quite generally held, that acute
diseases of the gastro-intestinal tract
render the individual more susceptible
to subsequent infection with typhoid
fever. However, our studies have forced
us to come to the following conclusions
concerning the relations between ty-phoid
fever and preceding temporary
disorders, including those diagnosed as
diarrhea, enteritis, gastro-enteritis, gas-tro-
duodenitis, intestinal catarrh, gastro-intestinal
catarrh, gastric fever, and
simple indigestion
:
(a) The temporary gastro-intestinal
disturbances of May and June had little
if any effect upon subsequent infection
with typhoid fever.
(6) The temporary gastro-intestinal
disturbances of July and August, instead
of predisposing to typhoid fever, gave a
certain degree of immunity against sub-sequent
infection with this disease. Our
investigations may be summarized as
follows
:
Of 9,481 men who had previous diar-rheal
attacks, 648, or 6.8 per cent.,
contracted typhoid fever ; whereas of
46,348 soldiers who had no preceding
diarrhea, 7,097, or 15.3 per cent., de-veloped
typhoid fever.
{5£) In a considerable per cent, (a little
more than one-third) of the cases of typhoid
fever xvhich are recorded as having been
preceded by some intestinal disturbance, the
preceding illness teas so closely folloived by
typhoid fever that we must regard the former
as having occurred ivithin the period of
incubation of the latter.
For particulars on this point see the
chapter on etiology.
{5S) More than 90 percent, of the men
xvho developed typhoid fever had no preced-ing
intestinal disorder.
In 7,745 cases in which this point was
especially investigated 7,097 (91.63 per
cent.) were not preceded by any intesti-nal
disorder.
{.57} The average period of incubation in
typhoid fever is probably about ten and a
half days.
Our data are not sufficient to enable us
to make any positive deduction on this
point, but from a careful study of 780
cases of typhoid feverin which the period
of incubation was based upon the aver-age
interval between connectable typhoid
attacks in tents or between diarrheal
and typhoidal attacks in the same indi-vidual
this was found to be 10.4 days.
The shortest period of incubation would
appear to be slightly less than eight
davs.
Revie-»v of Diseases for Jane, 1901.
KIXETY-OXE COUNTIES REPORTING.
Ninety-four counties have Superinten-dents
of Health.
Except in the case of the more conta-gious
and dangerous diseases the Super-intendent
has, as a rule, to rely upon his
own information alone, since few phy-sicians
can be induced to report cases of
non-contagious diseases to him.
"Where the number of cases is not given
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 49
or the prevalence of a disease otherwise
indicated, its mere presence in the county
is to be understood as reported.
For the month of June the following
diseases have been reported from the
counties named:
Measles.—Alexander, a few cases;
Beaufort, 1; Brunswick, several; Bun-combe,
3; Burke, 2; Caldwell, 20; Car-teret;
Columbus, a few; Currituck, a great
many; Duplin, 2; Graham, several; Gran-ville,
4; Haywood, several; Henderson,
13; Hyde, in all parts; Johnston; Lin-coln,
6; Macon, a few; Montgomery;
Moore, many; Perquimans, 50; Ran-dolph,
many; Eichmond, 5; Rocking-ham;
Stokes, 20; Watauga, epidemic;
Yadkin, general—27 counties.
Whooping-cough.—Cabarrus, 26; Cald-well,
10; Caswell, 1; Catawba, 4; Chat-ham;
Cleveland, several; Cumberland, a
few; Currituck, several; Durham, several;
Granville, 6; Iredell, several; Johnston;
Montgomery, 5; Moore, many; New
Hanover, 6; Orange; Polk, 8; Randolph,
general; Rockingham, a great many;
Rutherford, a few; Scotland, 11; Vance,
in all parts; Wake, 5; Watauga, many;
Wayne, a few; Wilson, 3; Yancey,
several—27 counties.
Scarlatina.—Buncombe, 14; Cleve-land,
a few; Davidson, 2; Durham, 4;
Iredell, 1; New Hanover, 1; Rowan, 1—7
counties.
Diphtheria.—Cabarrus, 1; New Han-over,
2; Polk, 1.
Typhoid Fever.—Alamance, 5; Alex-ander,
in all parts; Anson, a few; Ashe
2; Beaufort, 2; Brunswick, 5; Buncombe
3; Burke, 8; Cabarrus, 8; Caldwell, 6
Chatham, a few, of severe type; Cleve
land, several; Columbus, 4; Craven, G
Duplin, 4; Durham, 6; Edgecombe, 3
Franklin, 12 or 15; Gaston; Graham, 1
Granville, 4; Greene, 4; Halifax, 1
Harnett, a few; Hertford, 1; Iredell, 4;
Jones, 2; McDowell, 8; Macon, 6; Meck-lenburg,
4; Montgomery, 12; Nash, 7;
New Hanover, 14; Northampton, many;
Onslow, 3; Pender, 3; Perquimans, 2;
Polk, 9; Randolph, 10; Richmond, 10;
Robeson, a great many; Rockingham,
Rowan, 3; Sampson, a few; Scotland, 41;
20 or 30 of them at one cotton-mill;
Stanly; Stokes, 3; Surry, 2; Swain, 6;
Union, several; Vance, a few; Wake, 10;
Warren, 3; Wayne, several; Wilkes;
Yadkin, a few; Yancey, a few—57 coun-ties.
Malarial Fever.—Alamance, in all
parts; Anson; Beaufort; Brunswick;
Caswell; Chatham; Cherokee, 4 cases of
bilious fever; Craven, in all parts; Cur-rituck;
Gates; Graham, 1; Greene, in all
parts; Guilford; Halifax; Hertford; Hyde;
Iredell, 8; Jones; Montgomery; New Han-over,
in all parts; Onslow; Person; Samp-son;
Warren; W^ashington, in all parts;
Wayne; Wilkes; Wilson—27 counties.
Malarial Fever, Pernicious.—Beau-fort,
1; Hertford, 1; Hyde, 2; Washing-ton,
2.
Malarial Fever Hemorrhagic.—
Washington, 1; Wilson.
Diarrhceal Diseases, including Dys-entery.—
Alamance; Alleghany, in all
parts; Anson; Bertie; Brunswick; Burke,
in all parts; Caswell, in all parts; Ca-tawba;
Chatham; Cherokee, 30; Colum-bus,
in all parts; Currituck; Duplin;
Gates, in all parts; Graham; Granville;
Greene, in all parts; Halifax; Harnett;
Haywood; Jones; Lenoir; Lincoln; Mc-
Dowell; Mecklenberg; Mitchell; Moore;
Orange, in all parts; Pasquotank; Per-quimans;
Person; Randolph; Robeson;
Rockingham ; Rutheford ; Sampson ;
Stokes; Surry; Swain; Wake; Watauga;
W^ayne; Yancey—43 counties.
Influenza.—Union, a few cases.
50 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Mumps.—Caldwell, a few cases.
Small-pox.—Alamance, 9; Buncombe,
9; Burke, 1; Caswell, 1; Cleveland, 6;
Cumberland, 2; Durham, 10; Gaston, 8
(on July 4); Guilford, 6, one of these
was of the hemorrhagic form and fatal;
McDowell, 5; Mecklenburg, 8; Orange,
14; Person, 49; Rockingham, 2; Rowan,
1; Sampson, 1; Stanly, 3; Wake, 7.
Dr. J. W. Fulton, the Superintendent
of Health of Cherokee, writes: "I
visited the territory of the so-called
small-pox. I saw a number of the
patients and examined them carefully,
and if it is small-pox, it is not any small-pox
that I have seen heretofore. It is
on the line of this State and Georgia.
There have been, I suppose, one hundred
cases, with no deaths that can be attri-buted
to the disease that I know of. I
have advised steps to be taken to confine
the disease within the neighborhood."
Dr. J. G. Waldrop, Superintendent of
Health of Henderson county, says:
"We still have a few cases of what all
our physicians who see it call chicken-pox,
in severe form. I feel certain it
is that, but it is frightful in some cases.
I try to persuade them to keep others
away."
Varicella.—Wilson, a few.
Cholera ix Chickens.—Clay.
Cholera in Hogs.—Bertie, Columbus,
Hyde, Northampton, Pender, Richmond
and Robeson—7 counties.
No diseases reported from Bladen,
Chowan, Dare, Davie, Forsyth, Madison
and Pitt.
No reports from Jackson, Martin and
Transylvania.
Saininary of Mortuary Reports for
Jniie, 1901.
(twexty-one towns)
Aggregate popula- Wiite. Col'd. Total.
tion 63,870 39,760 103,630
Aggregate deaths... 102 111 213
Representing tem-porary
annual
death rate per
1,000 19.2 33.5 22 24.7
Causes of Death.
Typhoid Fever 549 Malarial fever 1 2 3
Whooping-cough ..0 6 6
Measles 1 1
Pneumonia 5 2 7
Consumption 9 13 22
Brain diseases 5 4 9
Heart diseases 2 7 9
Neurotic diseases... 3 3 6
Diarrhceal diseases 27 25 52
All other diseasses.. 40 41 81
Accident 3 4 7
Violence 10 1
102 111 213
Deaths under five
years 45 46 91
Still-born 17 8
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 51
mortuary Report for June, 1901.
Towns
AND RePOKTERS.
52 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
County Superintendents of nealtb.
Alamance Dr. H. R. Moore.
Alexander Dr. C. J. Carson.
Alleghany Dr. B. C. Waddell.
Anson Dr. J. H. Bennett.
Ashe Dr. J. W. Colvard.
Beaufort Dr. J no. G. Blount.
Bertie Dr. H. V. Dunstan.
Bladen Dr. Newton Robinson.
Brunswick Dr. J. A. McNeill.
Buncombe Dr. James Sawyer.
Burke Dr. J. L. Laxton.
Cabarrus Dr. R. S. Young.
Caldwell Dr. A. A. Kent.
Camden
Carteret Dr. F. M. Clark.
Caswell Dr. S. A. Malloy.
Catawba Dr. G6o. H. West.
Chatham Dr. H. T. Chapin
Cherokee Dr. J. F. Abernathy.
Chowan Dr. T. J. Hoskins.
Clay Dr. J. O. Nichols.
Cleveland Dr. B. H. Palmer.
Columbus Dr. I. Jackson.
Craven Dr.W. H. Street.
Cumberland Dr. Jno. D. McRae.
Currituck Dr. H. M. Shaw.
Dare Dr. W. B. Fearing.
Davidson Dr. Joel Hill.
Davie Dr. James McGuire.
Duplin Dr. O. F. Smith.
Durham Dr. N. M. Johnson.
Edgecombe Dr. L. L. Staton.
Forsyth Dr. John Bynum.
Franklin Dr. E. S. Foster.
Gaston Dr. J. H. Jenkins.
Gates Dr. W. 0. P. Lee.
Graham Dr. R. J. Orr.
Granville Dr. S. D. Booth.
Greene Dr. Joseph E. Grimsley.
Guilford Dr. Edmund Harrison.
Halifax Dr. I. E. Green.
Harnett Dr. O. L. Denning.
Haywood Dr. S. B. Medford.
Henderson Dr. J. G. Waldrop.
Hertford Dr. John W. Tayloe.
Hyde Dr. E. H. Jones.
Iredell Dr. Henry F. Long.
Jackson Dr. Wm. Self.
Johnston Dr. L. D. Wharton.
Jones Dr. S. E. Koonce.
Lenoir Dr. Ravmond Pollock.
Lincoln Dr. T. F. Costner.
McDowell Dr. B. A. Cheek.
Macon Dr. F. L. Siler.
Madison Dr. Jas. K. Hardwicke.
Martin Dr. W. H. Harrell.
Mecklenburg Dr. C. S. McLaughlin.
Mitchell Dr. V. R. Butt.
Montgomery Dr. M. P. Blair.
Moore Dr. Gilbert McLeod.
Nash Dr. J. P. Battle.
New Hanover Dr. W. D. McMillan.
Northampton Dr. H. W. Lewis.
Onslow Dr. E. L. Cox.
Orange Dr. D. C. Parris.
Pamlico
Pasquotank Dr. H. T. Aydlett.
Pender Dr. J. R. Thomson.
Perquimans Dr. C. 0. Winslow.
Person Dr. J. A. Wise.
Pitt Dr. C. O'H. Laughing.
house.
Polk Dr. Earle Grady.
Randolph Dr. S. Henley.
Richmond Dr. Wm P. Webb.
Robeson Dr. H. T. Pope.
Rockingham Dr. Sam Ellington.
Rowan Dr. W. L. Crump.
Rutherford Dr. T. B. Twitty.
Sampson Dr. R. E. Lee.
Scotland Dr. A. W. Hamer.
Stanly Dr. V. A. Whitley.
Stokes Dr. W. V. McCanless.
Surry Dr. John R. Woltz.
Swain Dr. J. A. Cooper.
Transylvania Dr. C. W. Hunt.
Tyrrell
Union Dr. J. E. Ashcraft.
Vance Dr. Goode Cheatham
Wake Dr. J. J. L. McCullere.
Warren Dr. A. S. Pendleton.
Washington Dr. W. H. AYard.
Watauga Dr. T C. Blackburn.
Wayne Dr. Williams Spicer.
Wilkes Dr J. M. Turner.
Wilson Dr. W. S. Anderson.
Yadkin Dr. S. L. Russell.
Yancey Dr. W. M. Austin.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 53
[You are asked to fill out and mail one of these forms to the Superintendent of Health of your
county on or before the third of each month, that he may use it in making his report to the Secretary
of the State Board.
Have any of the following diseases occurred in your practice during the month
jus